Healthcare Provider Details

I. General information

NPI: 1669091476
Provider Name (Legal Business Name): MICHAELLA SCOPEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2020
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

PO BOX 1705
MEDFORD OR
97501-0132
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5914
  • Fax:
Mailing address:
  • Phone: 541-773-7273
  • Fax: 541-773-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD224481
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: