OrganizationPonderosa MedicalInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address1558 SW Nancy Way, Suite 101, Bend, OR 97702-3216(541) 312-8679PECOS EnrollmentBased on the most recent information from CMS, provider Ponderosa Medical does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1710931274Provider TypeOrganizationFull NamePonderosa MedicalSubpartNoEnumeration Date5/20/2006Last Updated8/22/2020Contact InformationPractice LocationPractice Address1558 SW Nancy Way, Suite 101, Bend, OR 97702-3216Phone(541) 312-8679FaxUnlisted FaxMailing LocationMailing Address1558 SW Nancy Way, Suite 101, Bend, OR 97702-3216Phone(541) 312-8679FaxUnlisted FaxAuthorized OfficialNameLee, Gilbert B (Physician)Phone(541) 312-8679Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseMD12002Oregon