Healthcare Provider Details

I. General information

NPI: 1801829346
Provider Name (Legal Business Name): MEDFORD WOMENS CLINIC LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date: 11/10/2022
Reactivation Date: 12/06/2022

III. Provider practice location address

3170 STATE ST
MEDFORD OR
97504-8450
US

IV. Provider business mailing address

3170 STATE ST
MEDFORD OR
97504-8450
US

V. Phone/Fax

Practice location:
  • Phone: 541-864-8900
  • Fax: 541-245-3315
Mailing address:
  • Phone: 541-864-8900
  • Fax: 541-245-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateOR

VIII. Authorized Official

Name: MRS. ALISA ANN SEE
Title or Position: OFFICE LEAD
Credential:
Phone: 541-864-8906