| NPI | 1386713972 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP SOUTH |
| Doing Business As | PMG SOUTH MEDFORD FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollment 425-358-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2025-11-19 |