| NPI | 1699827477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE DOVER Credentialing COO Rdinator 541-706-2495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207RC0000X Internal Medicine Cardiovascular Disease | |
| 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism | |
| 207RG0100X Internal Medicine Gastroenterology | |
| 207RH0003X Internal Medicine Hematology & Oncology | |
| 207RN0300X Internal Medicine Nephrology | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery | |
| 207N00000X Dermatology | |
| 207RP1001X Internal Medicine Pulmonary Disease | |
| 207RR0500X Internal Medicine Rheumatology | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 207RX0202X Internal Medicine Medical Oncology | |
| 207W00000X Ophthalmology | |
| 208600000X Surgery | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2023-04-21 |