Healthcare Provider Details

I. General information

NPI: 1427139732
Provider Name (Legal Business Name): OREGON SURGICAL SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL CENTER DR STE 300
MEDFORD OR
97504-4316
US

IV. Provider business mailing address

520 MEDICAL CENTER DR STE 300
MEDFORD OR
97504-4316
US

V. Phone/Fax

Practice location:
  • Phone: 541-930-8907
  • Fax: 541-282-6710
Mailing address:
  • Phone: 541-930-8907
  • Fax: 541-282-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID L STREET
Title or Position: PRESIDENT OF CORPORATION
Credential: M.D.
Phone: 541-930-8907