Healthcare Provider Details

I. General information

NPI: 1831199074
Provider Name (Legal Business Name): JEFFREY ALLEN LOUIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/08/2007
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: 541-818-9434
Mailing address:
  • Phone: 541-779-1672
  • Fax: 541-818-9434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD15097
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberG57530
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number23998
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: