Healthcare Provider Details

I. General information

NPI: 1508271701
Provider Name (Legal Business Name): EMRE KOCA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 01/18/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 E BARNETT RD
MEDFORD OR
97504
US

IV. Provider business mailing address

PO BOX 4749
MEDFORD OR
97501-0227
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-4673
  • Fax: 541-789-2121
Mailing address:
  • Phone: 541-789-4111
  • Fax: 541-789-5518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD195258
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.064385
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: