Healthcare Provider Details

I. General information

NPI: 1497172761
Provider Name (Legal Business Name): TAMARA LYNN HOUSTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 AIRPORT RD
MEDFORD OR
97504-4159
US

IV. Provider business mailing address

3203 WILLAMETTE ST
EUGENE OR
97405-3348
US

V. Phone/Fax

Practice location:
  • Phone: 541-200-2900
  • Fax: 541-200-2949
Mailing address:
  • Phone: 541-726-9912
  • Fax: 541-744-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA166331
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA166331
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: