Healthcare Provider Details

I. General information

NPI: 1528052271
Provider Name (Legal Business Name): JOHN G APOSTOL M.D., P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E MAIN ST
MEDFORD OR
97504-7133
US

IV. Provider business mailing address

815 E MAIN ST
MEDFORD OR
97504-7133
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-6395
  • Fax: 541-772-8392
Mailing address:
  • Phone: 541-779-6395
  • Fax: 541-772-8392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD07166
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: