Healthcare Provider Details

I. General information

NPI: 1427068519
Provider Name (Legal Business Name): CINDY ANN KONECNE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
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 NumberDO20779
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: