Healthcare Provider Details

I. General information

NPI: 1508816794
Provider Name (Legal Business Name): SOUTHERN OREGON HOSPITALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 E BARNETT RD
MEDFORD OR
97504-8332
US

IV. Provider business mailing address

2640 E BARNETT RD E333
MEDFORD OR
97504-4301
US

V. Phone/Fax

Practice location:
  • Phone: 541-282-6770
  • Fax:
Mailing address:
  • Phone: 541-282-6770
  • Fax: 541-282-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number206311-95
License Number StateOR

VIII. Authorized Official

Name: ASHAN JAFFAR
Title or Position: PRESIDENT
Credential: MD
Phone: 541-282-6770