Healthcare Provider Details

I. General information

NPI: 1699761932
Provider Name (Legal Business Name): ROGUE VALLEY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 DOCTORS PARK DR
MEDFORD OR
97504-8127
US

IV. Provider business mailing address

2900 DOCTORS PARK DR
MEDFORD OR
97504-8127
US

V. Phone/Fax

Practice location:
  • Phone: 541-842-9649
  • Fax: 541-282-2237
Mailing address:
  • Phone: 541-842-9649
  • Fax: 541-282-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM J SLOAN
Title or Position: CFO
Credential:
Phone: 541-842-9649