Healthcare Provider Details

I. General information

NPI: 1831148196
Provider Name (Legal Business Name): MARJORIE NICOLE HARVILL-BROOKS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARJORIE NICOLE HARVILL DO

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 ROYAL AVE SUITE 350
MEDFORD OR
97504-6193
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 541-732-7460
  • Fax: 541-732-7461
Mailing address:
  • Phone: 541-732-7460
  • Fax: 541-732-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO154075
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberDO154075
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: