Provider Demographics
NPI:1487009635
Name:SELCHAU, AMANDA MAE (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAE
Last Name:SELCHAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2450 NE MARY ROSE PL STE 110
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7132
Mailing Address - Country:US
Mailing Address - Phone:541-749-4997
Mailing Address - Fax:541-389-2756
Practice Address - Street 1:2450 NE MARY ROSE PL STE 110
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7132
Practice Address - Country:US
Practice Address - Phone:541-749-4997
Practice Address - Fax:541-389-2756
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
282N00000X
ORMD221364207W00000X
TXS5264207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No282N00000XHospitalsGeneral Acute Care Hospital