Healthcare Provider Details

I. General information

NPI: 1225225113
Provider Name (Legal Business Name): JAMES W. THEEN, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 TOWN CENTRE DR SUITE B
MEDFORD OR
97504-6172
US

IV. Provider business mailing address

935 TOWN CENTRE DR SUITE B
MEDFORD OR
97504-6172
US

V. Phone/Fax

Practice location:
  • Phone: 541-245-6050
  • Fax:
Mailing address:
  • Phone: 541-245-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD16267
License Number StateOR

VIII. Authorized Official

Name: DR. JAMES WILLIAM THEEN
Title or Position: PRESIDENT
Credential: MD
Phone: 541-245-6050