Healthcare Provider Details

I. General information

NPI: 1699775924
Provider Name (Legal Business Name): LUCIEN T MEGNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 02/14/2024
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SW RAMSEY AVE
GRANTS PASS OR
97527-5535
US

IV. Provider business mailing address

2825 E BARNETT RD MSS
MEDFORD OR
97504-8332
US

V. Phone/Fax

Practice location:
  • Phone: 541-472-7810
  • Fax: 541-472-7811
Mailing address:
  • Phone: 541-789-4207
  • Fax: 541-789-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00034155
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD205344
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: