Healthcare Provider Details

I. General information

NPI: 1477549194
Provider Name (Legal Business Name): INSTITUTE OF DIABETES AND ENDOCRINOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W STEWART AVE SUITE 101
MEDFORD OR
97501-3609
US

IV. Provider business mailing address

221 W STEWART AVE SUITE 101
MEDFORD OR
97501-3609
US

V. Phone/Fax

Practice location:
  • Phone: 541-776-2003
  • Fax: 541-796-9833
Mailing address:
  • Phone: 541-776-2003
  • Fax: 541-796-9833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD21000
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD21518
License Number StateOR

VIII. Authorized Official

Name: MR. RICHARD L EDDY
Title or Position: PRESIDENT CEO
Credential: MD
Phone: 541-776-2003