Basic Information
| Provider Information | |||||||||
| NPI: | 1972699163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAUERWEIN | ||||||||
| FirstName: | MARK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 NE NEFF RD | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977016015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413824321 | ||||||||
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| Practice Location | |||||||||
| Address1: | 630 N ARROWLEAF TRL | ||||||||
| Address2: | |||||||||
| City: | SISTERS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415491318 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00023742 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | SA8523 | 01 | WA | REGENCE | OTHER | 1015585 | 01 | WA | CHPW | OTHER | 911019392 | 01 | COMMERCIAL | OTHER | 1015585 | 05 | WA | MEDICAID | 22852 | 01 | GROUP HEALTH | OTHER | 100979 | 01 | WA | L & I | OTHER |