Basic Information
| Provider Information | |||||||||
| NPI: | 1992793988 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LACHMAN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | G. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 NE PROFESSIONAL CT | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413896313 | ||||||||
| FaxNumber: | 5413898760 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 NE PROFESSIONAL CT | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977016063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413896313 | ||||||||
| FaxNumber: | 5413898760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 04/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD2004-0564 | NM | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD28419 | OR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 8755566 | 05 | NM | MEDICAID |