Healthcare Provider Details

I. General information

NPI: 1235828575
Provider Name (Legal Business Name): MEUMBUR PRAISE KPUGHUR-TULE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date: 12/07/2023
Reactivation Date: 12/22/2023

III. Provider practice location address

500 SW RAMSEY AVE
GRANTS PASS OR
97527-5554
US

IV. Provider business mailing address

500 SW RAMSEY AVE
GRANTS PASS OR
97527-5554
US

V. Phone/Fax

Practice location:
  • Phone: 541-472-7000
  • Fax:
Mailing address:
  • Phone: 541-472-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD228552
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: