Provider Demographics
NPI:1548245640
Name:VANAMBURG, JANA M (MD)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:M
Last Name:VANAMBURG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:M
Other - Last Name:JADERBORG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2275 NE DOCTORS DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6324
Mailing Address - Country:US
Mailing Address - Phone:541-323-2790
Mailing Address - Fax:541-636-0898
Practice Address - Street 1:2275 NE DOCTORS DR
Practice Address - Street 2:SUITE 7
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6324
Practice Address - Country:US
Practice Address - Phone:541-323-2790
Practice Address - Fax:541-636-0898
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23515208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR268652Medicaid
132074Medicare ID - Type Unspecified
OR268652Medicaid