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General NPI Number Information
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NPI Number | 1699908475
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Entity Type | Organization
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Legal Business Name | ROGUE VALLEY ORAL & MAXILLOFACIAL SURGERY, PC
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 460 MURPHY ROAD
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City | MEDFORD
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State | OR
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Zip | 97504
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Country | US
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Telephone | 541-776-0050
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Fax | 541-776-0062
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Provider Business Mailing Address
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Address Line | 460 MURPHY ROAD
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City | MEDFORD
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State | OR
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Zip | 97504
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Country | US
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Telephone | 541-776-0050
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Fax | 541-776-0062
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Authorized Official
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Title or Position | SURGEON/PRESIDENT
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Name | DR. MICHAEL J. DOHERTY
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Credential | DDS, FACS
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Telephone | 541-776-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | D9230
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License Number State | OR
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