Healthcare Provider Details

I. General information

NPI: 1780909408
Provider Name (Legal Business Name): JEFFERSON NEUROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BRYANT WILLIAMS DR STE 1
KLAMATH FALLS OR
97601-1121
US

IV. Provider business mailing address

1801 HIGHWAY 99 N STE 2
ASHLAND OR
97520-9152
US

V. Phone/Fax

Practice location:
  • Phone: 541-880-2902
  • Fax: 541-884-0848
Mailing address:
  • Phone: 541-482-5515
  • Fax: 541-482-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD25117
License Number StateOR

VIII. Authorized Official

Name: DR. ZAKIR M ALI
Title or Position: OWNDER
Credential: MD
Phone: 541-488-5515