Healthcare Provider Details

I. General information

NPI: 1891730826
Provider Name (Legal Business Name): LINDA RUTH HARRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W STEWART AVE STE 101
MEDFORD OR
97501-3609
US

IV. Provider business mailing address

931 CHEVY WAY
MEDFORD OR
97504-4127
US

V. Phone/Fax

Practice location:
  • Phone: 541-690-3500
  • Fax:
Mailing address:
  • Phone: 541-535-6239
  • Fax: 541-512-1026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD14558
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: