Healthcare Provider Details

I. General information

NPI: 1518093376
Provider Name (Legal Business Name): SOUTHERN OREGON ORTHOPEDICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 E BARNETT RD STE 200
MEDFORD OR
97504-8674
US

IV. Provider business mailing address

2780 E BARNETT RD STE 200
MEDFORD OR
97504-8674
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-6250
  • Fax: 541-608-2535
Mailing address:
  • Phone: 541-779-6250
  • Fax: 541-608-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOR

VIII. Authorized Official

Name: PATRICK J DENARD
Title or Position: OWNER / MD
Credential: MD
Phone: 541-779-6250