Healthcare Provider Details

I. General information

NPI: 1174794895
Provider Name (Legal Business Name): FAYE AMEREDES DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 NW STEWART PKWY STE 240
ROSEBURG OR
97471
US

IV. Provider business mailing address

PO BOX 816
ROSEBURG OR
97470
US

V. Phone/Fax

Practice location:
  • Phone: 541-677-4463
  • Fax: 541-677-3379
Mailing address:
  • Phone: 541-677-4463
  • Fax: 541-677-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO22718
License Number StateOR

VIII. Authorized Official

Name: KENDRA R MURRAY
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-677-4463