MEDICARE: WILLIAM CHARLES HUSUM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD09744	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528082666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM CHARLES HUSUM MD

Provider Business Mailing Address
First Line	:	2900 DOCTORS PARK DR
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-8127
Country	:	US
Telephone Number	:	541-282-2200
Fax Number	:	541-282-2237

Provider Business Practice Location Address
First Line	:	2900 DOCTORS PARK DR
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-8127
Country	:	US
Telephone Number	:	541-282-2200
Fax Number	:	541-282-2237

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	01/14/2008

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