Healthcare Provider Details

I. General information

NPI: 1437337789
Provider Name (Legal Business Name): EDWARD ORVILLE BLEWS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BLACK OAK DR STE 300
MEDFORD OR
97504-8491
US

IV. Provider business mailing address

2825 E BARNETT RD
MEDFORD OR
97504-8332
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-4505
  • Fax: 541-789-4502
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA105699
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA105699
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD228637
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD228637
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: