Healthcare Provider Details

I. General information

NPI: 1598971038
Provider Name (Legal Business Name): TIMO NIILO DYGERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TIMOTHY NIILO DYGERT M.D.

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL CENTER DRIVE
MEDFORD OR
97504-4314
US

IV. Provider business mailing address

520 MEDICAL CENTER DRIVE
MEDFORD OR
97504-4314
US

V. Phone/Fax

Practice location:
  • Phone: 541-930-7222
  • Fax:
Mailing address:
  • Phone: 541-930-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD28409
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD28409
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: