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General NPI Number Information
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NPI Number | 1841879509
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Entity Type | Organization
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Legal Business Name | SUNSTONE PRIMARY CARE PC
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 540 CATALINA DR
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City | ASHLAND
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State | OR
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Zip | 97520-1605
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Country | US
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Telephone | 541-727-8972
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Fax | 833-638-0201
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Provider Business Mailing Address
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Address Line | 540 CATALINA DR
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City | ASHLAND
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State | OR
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Zip | 97520-1605
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Country | US
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Telephone | 541-727-8972
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Fax | 833-638-0201
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD CLARK CULLEN
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Credential | MD
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Telephone | 541-727-8972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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