Provider Demographics
NPI:1699949222
Name:CZYSZCZON, IRENE (DO)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:CZYSZCZON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 NE CUSHING DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3876
Mailing Address - Country:US
Mailing Address - Phone:541-382-7696
Mailing Address - Fax:541-389-5723
Practice Address - Street 1:1348 NE CUSHING DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3876
Practice Address - Country:US
Practice Address - Phone:541-382-7696
Practice Address - Fax:541-389-5723
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO166251207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology