Healthcare Provider Details

I. General information

NPI: 1184604100
Provider Name (Legal Business Name): DANIELA O MARJANOVIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W HARVARD AVE
ROSEBURG OR
97471-2550
US

IV. Provider business mailing address

PO BOX 1272
ROSEBURG OR
97470
US

V. Phone/Fax

Practice location:
  • Phone: 541-673-0215
  • Fax: 641-673-2864
Mailing address:
  • Phone: 541-673-0215
  • Fax: 541-673-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD12634
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: