Healthcare Provider Details

I. General information

NPI: 1962637058
Provider Name (Legal Business Name): GI ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 NW MEDICAL PARK DR
ROSEBURG OR
97471-5510
US

IV. Provider business mailing address

2560 NW MEDICAL PARK DR
ROSEBURG OR
97471-5510
US

V. Phone/Fax

Practice location:
  • Phone: 541-673-2044
  • Fax: 541-673-0454
Mailing address:
  • Phone: 541-673-2044
  • Fax: 541-673-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD12260
License Number StateOR

VIII. Authorized Official

Name: THOMAS J HARPOLE
Title or Position: CORP PRESIDENT
Credential: MD
Phone: 541-673-2044