Healthcare Provider Details

I. General information

NPI: 1265065049
Provider Name (Legal Business Name): JACK FRANCIS COBURN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S GARDEN WAY STE 140
EUGENE OR
97401-8181
US

IV. Provider business mailing address

2943 RIVERWALK LOOP
EUGENE OR
97401-1504
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-9750
  • Fax:
Mailing address:
  • Phone: 503-806-9210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD12315
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: