Healthcare Provider Details

I. General information

NPI: 1073609343
Provider Name (Legal Business Name): WILLIAM F STROCK MS CLINICAL AUDIOLOG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 HAWTHORNE ST
MEDFORD OR
97504
US

IV. Provider business mailing address

2162 HAPPY VALLEY DR
MEDFORD OR
97501
US

V. Phone/Fax

Practice location:
  • Phone: 541-776-3461
  • Fax: 541-776-0482
Mailing address:
  • Phone: 541-779-7914
  • Fax: 541-779-7914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberOR20448
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: