Healthcare Provider Details

I. General information

NPI: 1740378173
Provider Name (Legal Business Name): ALAN P. MERSCH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 S. FRONT ST. SUITE 200
CENTRAL POINT OR
97502
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 541-664-3346
  • Fax: 541-732-8051
Mailing address:
  • Phone: 541-664-3346
  • Fax: 541-664-6051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD010913
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: