Healthcare Provider Details

I. General information

NPI: 1093169104
Provider Name (Legal Business Name): APP ENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 UNION AVE SECOND FLOOR -2C
GRANTS PASS OR
97527-5543
US

IV. Provider business mailing address

PO BOX 748157
LOS ANGELES CA
90074-8157
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-7775
  • Fax: 541-476-3572
Mailing address:
  • Phone: 541-789-5250
  • Fax: 541-789-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK HOCKING
Title or Position: CAFO
Credential:
Phone: 541-789-4916