Healthcare Provider Details

I. General information

NPI: 1265542401
Provider Name (Legal Business Name): PHYSICIANS MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 NW HAWTHORNE AVE STE 201
GRANTS PASS OR
97526-6009
US

IV. Provider business mailing address

1619 NW HAWTHORNE AVE STE 201
GRANTS PASS OR
97526-6009
US

V. Phone/Fax

Practice location:
  • Phone: 541-474-1020
  • Fax:
Mailing address:
  • Phone: 541-474-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. VICKIE STEPHENS
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-474-1020