Healthcare Provider Details

I. General information

NPI: 1043371305
Provider Name (Legal Business Name): PAUL J FIEBER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 NW EDENBOWER BLVD SUITE 100
ROSEBURG OR
97471-6214
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: 541-229-3362
Mailing address:
  • Phone: 541-677-7200
  • Fax: 541-229-3362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00806
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: