Healthcare Provider Details

I. General information

NPI: 1942581012
Provider Name (Legal Business Name): GARY JOSEPHSEN M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 G ST
SPRINGFIELD OR
97477-4112
US

IV. Provider business mailing address

PO BOX 11840
WESTMINSTER CA
92685-1840
US

V. Phone/Fax

Practice location:
  • Phone: 541-726-4400
  • Fax:
Mailing address:
  • Phone: 562-468-0227
  • Fax: 562-468-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY D JOSEPHSEN
Title or Position: M.D.
Credential: M.D.
Phone: 541-726-4400