Healthcare Provider Details

I. General information

NPI: 1609880368
Provider Name (Legal Business Name): LINDA L SEWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2564 NW EDENBOWER BLVD STE 134
ROSEBURG OR
97471
US

IV. Provider business mailing address

2564 NW EDENBOWER BLVD STE 134
ROSEBURG OR
97471
US

V. Phone/Fax

Practice location:
  • Phone: 541-492-2350
  • Fax: 541-492-2346
Mailing address:
  • Phone: 541-492-2350
  • Fax: 541-492-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD26760
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: