Maciey J Druzdzel MD PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

MD18563 Issued in OR

Legal business name

MACIEY J DRUZDZEL MD PC

Practice address

29593 Ellensburg Ave.
Gold Beach, OR 97444-1650

Phone

(154) 124-7949

Fax

(154) 124-7967

NPI assigned

Jul 20, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Maciey J Druzdzel, MD

Title

President

Phone

(541) 247-9499

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342742400000",
    "number": "1811242308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1650",
            "address_2": "29593 ELLENSBURG",
            "city": "GOLD BEACH",
            "state": "OR",
            "postal_code": "974441650",
            "telephone_number": "154-124-7949",
            "fax_number": "154-124-7967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29593 ELLENSBURG AVE.",
            "city": "GOLD BEACH",
            "state": "OR",
            "postal_code": "974441650",
            "telephone_number": "154-124-7949",
            "fax_number": "154-124-7967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACIEY J DRUZDZEL MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-20",
        "last_updated": "2012-07-20",
        "status": "A",
        "authorized_official_last_name": "DRUZDZEL",
        "authorized_official_first_name": "MACIEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "15412479499",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OR",
            "license": "MD18563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121280",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "R104978",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rajean Lakson
• Darcee Landes
• Stephanie Ann Laudert, MD
• Frankie Lemmons, LMHC, LPC
• Herman G. T. Liem, D. D. S.
• Mahant LLC
• Bob Manners, DC
• William Marshall
• Jennifer Martino
• Kely McConnell Regan

• Primary Care Clinic/Center in Gold Beach, OR
• Providers in Gold Beach, OR by specialty
• Primary Care Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.