Healthcare Provider Details

I. General information

NPI: 1255302444
Provider Name (Legal Business Name): CHRIS ANTHONY JANNELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 02/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 NW STEWART PKWY
ROSEBURG OR
97470-1281
US

IV. Provider business mailing address

2700 NW STEWART PKWY
ROSEBURG OR
97470-1281
US

V. Phone/Fax

Practice location:
  • Phone: 541-677-4313
  • Fax: 541-677-4533
Mailing address:
  • Phone: 541-677-4313
  • Fax: 541-677-4533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD15609
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD15609
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: