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General NPI Number Information
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NPI Number | 1104922749
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Entity Type | Organization
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Legal Business Name | UROLOGY ASSOCIATES OF SOUTHERN OREGON, LLP
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2900 DOCTORS PARK DR SUITE 100
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City | MEDFORD
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State | OR
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Zip | 97504-8198
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Country | US
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Telephone | 541-772-6600
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Fax | 541-779-1266
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Provider Business Mailing Address
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Address Line | 2900 DOCTORS PARK DRIVE SUITE 100
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City | MEDFORD
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State | OR
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Zip | 97504-6111
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Country | US
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Telephone | 541-772-6600
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Fax | 541-779-1266
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. NANCY JEAN FADLING
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Credential | MBA
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Telephone | 541-772-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | OR
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