Healthcare Provider Details

I. General information

NPI: 1548226582
Provider Name (Legal Business Name): JAIRUS SATHIANATHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAIRUS SATHIANATHAN

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937 W HARVARD AVE
ROSEBURG OR
97471-2720
US

IV. Provider business mailing address

2570 NW EDENBOWER BLVD. SUITE 100
ROSEBURG OR
97471-6214
US

V. Phone/Fax

Practice location:
  • Phone: 541-677-7200
  • Fax: 541-229-3309
Mailing address:
  • Phone: 541-677-7200
  • Fax: 541-229-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD25568
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD25568
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: