Healthcare Provider Details

I. General information

NPI: 1639197742
Provider Name (Legal Business Name): MARTHA MARIE CAVAZOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 CATALINA DR
ASHLAND OR
97520-1605
US

IV. Provider business mailing address

2620 E BARNETT RD
MEDFORD OR
97504-8344
US

V. Phone/Fax

Practice location:
  • Phone: 541-201-4800
  • Fax: 541-201-4815
Mailing address:
  • Phone: 541-789-4281
  • Fax: 541-789-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD25511
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: