Healthcare Provider Details

I. General information

NPI: 1669367074
Provider Name (Legal Business Name): JAY PANCHAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 CATALINA DR STE 200
ASHLAND OR
97520-1605
US

IV. Provider business mailing address

2825 E BARNETT RD # MSS
MEDFORD OR
97504-8332
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA232901
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: