Healthcare Provider Details

I. General information

NPI: 1043379860
Provider Name (Legal Business Name): JASON HARLOW FRIESEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1488 OAK ST
EUGENE OR
97401-4043
US

IV. Provider business mailing address

1488 OAK ST
EUGENE OR
97401-4043
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-1577
  • Fax: 541-344-6176
Mailing address:
  • Phone: 541-683-1577
  • Fax: 541-344-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD26220
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: