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General NPI Number Information
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NPI Number | 1699392985
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Entity Type | Organization
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Legal Business Name | ROXYANN DERMATOLOGY, LLC
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 3210 HILLCREST PARK DR STE 100
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City | MEDFORD
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State | OR
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Zip | 97504-7687
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Country | US
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Telephone | 541-261-6412
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Fax |
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Provider Business Mailing Address
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Address Line | 6200 HILLCREST RD
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City | MEDFORD
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State | OR
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Zip | 97504-9037
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Country | US
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Telephone | 541-261-6412
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LILIANA RAYBURN
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Credential |
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Telephone | 541-261-6412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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