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General NPI Number Information
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NPI Number | 1205863990
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Entity Type | Individual
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Provider Name | JAMES WILLIAM THEEN MD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 07/19/2017
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Provider Practice Location Address
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Address Line | 555 BLACK OAK DR
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City | MEDFORD
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State | OR
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Zip | 97504-8447
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Country | US
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Telephone | 541-734-3430
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Fax | 541-734-3638
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Provider Business Mailing Address
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Address Line | 3625 OLD CHERRY LN
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City | MEDFORD
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State | OR
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Zip | 97504-9476
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Country | US
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Telephone | 541-734-3430
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Fax | 541-734-3638
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD16267
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License Number State | OR
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