Healthcare Provider Details

I. General information

NPI: 1083309520
Provider Name (Legal Business Name): JENNIFER TEMITOPE JEBODA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 MURPHY RD STE 107
MEDFORD OR
97504-4311
US

IV. Provider business mailing address

2825 E BARNETT RD MSS
MEDFORD OR
97504-8332
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-6460
  • Fax: 541-789-6461
Mailing address:
  • Phone: 541-789-4200
  • Fax: 541-789-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD229122
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: