Healthcare Provider Details

I. General information

NPI: 1619019288
Provider Name (Legal Business Name): PATRICE M FRIRES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 S PACIFIC HWY
MEDFORD OR
97501-8957
US

IV. Provider business mailing address

931 CHEVY WAY
MEDFORD OR
97504-4127
US

V. Phone/Fax

Practice location:
  • Phone: 541-552-1111
  • Fax: 541-482-9066
Mailing address:
  • Phone: 541-690-3555
  • Fax: 541-482-9066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number087006120
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: