Provider Demographics
NPI:1306912035
Name:SCHOENFELDER, ELLEN K (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:K
Last Name:SCHOENFELDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 SUNSET DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850
Mailing Address - Country:US
Mailing Address - Phone:541-963-4139
Mailing Address - Fax:541-963-4412
Practice Address - Street 1:710 SUNSET DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850
Practice Address - Country:US
Practice Address - Phone:541-963-4139
Practice Address - Fax:541-963-4412
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165043Medicaid
B85235Medicare UPIN
0000BHWSNMedicare ID - Type Unspecified