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General NPI Number Information
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NPI Number | 1023212925
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW UROLOGY PC
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2640 BIEHN ST
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-1181
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Country | US
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Telephone | 541-884-9312
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Fax | 541-884-0930
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Provider Business Mailing Address
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Address Line | 2640 BIEHN ST
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-1181
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Country | US
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Telephone | 541-884-9312
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Fax | 541-884-0930
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHARON HARGAN RAIFE
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Credential |
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Telephone | 541-884-9312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD23162
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License Number State | OR
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