Healthcare Provider Details

I. General information

NPI: 1871518514
Provider Name (Legal Business Name): HARVEY HWANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 E MAIN ST
MEDFORD OR
97504-7134
US

IV. Provider business mailing address

PO BOX 1705
MEDFORD OR
97501-0132
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-7273
  • Fax: 541-773-2027
Mailing address:
  • Phone: 541-773-7273
  • Fax: 541-773-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15176
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: