Healthcare Provider Details

I. General information

NPI: 1760489181
Provider Name (Legal Business Name): JEAN T. BIERAUGEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BLACK OAK DR SUITE 100
MEDFORD OR
97504-8447
US

IV. Provider business mailing address

555 BLACK OAK DR SUITE 100
MEDFORD OR
97504-8447
US

V. Phone/Fax

Practice location:
  • Phone: 541-734-3430
  • Fax: 541-732-3980
Mailing address:
  • Phone: 541-734-3430
  • Fax: 541-734-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD19727
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: