Healthcare Provider Details

I. General information

NPI: 1912288671
Provider Name (Legal Business Name): SOUTHERN OREGON NEUROSURGICAL & SPINE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 06/17/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 HILLCREST RAOD
MEDFORD OR
97504
US

IV. Provider business mailing address

3270 HILLCREST RAOD
MEDFORD OR
97504-8475
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-1672
  • Fax:
Mailing address:
  • Phone: 541-779-1672
  • Fax: 541-779-0986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MIROSLAV BOBEK
Title or Position: PHYSICIAN
Credential: MD
Phone: 541-779-1672