Provider Demographics
NPI:1154354868
Name:TENSCHER, MAX (FNP)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:TENSCHER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-0422
Mailing Address - Country:US
Mailing Address - Phone:541-535-9108
Mailing Address - Fax:541-535-8809
Practice Address - Street 1:312 E MAIN
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540
Practice Address - Country:US
Practice Address - Phone:541-535-9108
Practice Address - Fax:541-535-8809
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR91007287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000662OtherOMAP
OR804693002OtherBLUE CROSS
ORA003OtherTRICARE
ORA003OtherTRICARE
OR113763Medicare ID - Type Unspecified