Provider Demographics
NPI:1780795625
Name:FOHRMAN, DANIEL E (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:FOHRMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2200 NE NEFF RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4283
Mailing Address - Country:US
Mailing Address - Phone:541-388-2232
Mailing Address - Fax:541-278-8366
Practice Address - Street 1:2200 NE NEFF RD
Practice Address - Street 2:STE 302
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4279
Practice Address - Country:US
Practice Address - Phone:541-388-2232
Practice Address - Fax:541-278-8366
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12275174400000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR234203Medicaid
OR00469972OtherRAILROAD MEDICARE
OR011WCGMFCMedicare ID - Type Unspecified
ORC91511Medicare UPIN