Healthcare Provider Details

I. General information

NPI: 1053583377
Provider Name (Legal Business Name): JENNIFER M. SOYKE, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 STEWART PARKWAY MERCY MEDICAL CENTER EMERGENCY DEPARTMENT
ROSEBURG OR
94740
US

IV. Provider business mailing address

2035 LAW LANE
EUGENE OR
97401-5425
US

V. Phone/Fax

Practice location:
  • Phone: 541-673-0611
  • Fax:
Mailing address:
  • Phone: 541-912-4258
  • Fax: 541-345-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD19236
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberMD19236
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD19236
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberMD 19236
License Number StateOR

VIII. Authorized Official

Name: DR. JENNIFER MAE SOYKE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 541-912-4258