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General NPI Number Information
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NPI Number | 1538219993
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Entity Type | Organization
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Legal Business Name | NORTHWEST PAIN MANAGEMENT PC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1322 E MCANDREWS RD SUITE 101
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City | MEDFORD
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State | OR
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Zip | 97504-6177
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Country | US
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Telephone | 541-770-1650
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Fax | 541-773-2470
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Provider Business Mailing Address
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Address Line | 1322 E MCANDREWS RD SUITE 101
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City | MEDFORD
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State | OR
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Zip | 97504-6177
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Country | US
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Telephone | 541-770-1650
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Fax | 541-773-2470
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS JOHN PURTZER
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Credential | M.D.
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Telephone | 541-770-1650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 12880
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License Number State | OR
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