Healthcare Provider Details

I. General information

NPI: 1336149954
Provider Name (Legal Business Name): MEDFORD NEURO CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 STATE ST
MEDFORD OR
97504-8475
US

IV. Provider business mailing address

2900 STATE ST
MEDFORD OR
97504-8475
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-1672
  • Fax: 541-618-9434
Mailing address:
  • Phone: 541-779-1672
  • Fax: 541-618-9434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL STEVEN NARUS
Title or Position: PRESIDENT
Credential: DO
Phone: 541-779-1672