Healthcare Provider Details

I. General information

NPI: 1346254547
Provider Name (Legal Business Name): JOHN PAUL SHONERD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 HEATHROW WAY
MEDFORD OR
97504-2770
US

IV. Provider business mailing address

2900 DOCTORS PARK DR
MEDFORD OR
97504-8127
US

V. Phone/Fax

Practice location:
  • Phone: 541-646-3505
  • Fax: 541-646-3553
Mailing address:
  • Phone: 541-282-2200
  • Fax: 541-282-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO13134
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: