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General NPI Number Information
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NPI Number | 1881263721
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Entity Type | Organization
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Legal Business Name | ELKHORN FAMILY MEDICINE PC
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Dates
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Enumeration Date | 06/24/2021
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 3705 MIDWAY DR
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City | BAKER CITY
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State | OR
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Zip | 97814-1456
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Country | US
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Telephone | 541-519-4204
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Fax |
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Provider Business Mailing Address
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Address Line | 3705 MIDWAY DR
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City | BAKER CITY
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State | OR
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Zip | 97814-1456
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Country | US
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Telephone | 541-519-4204
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOGAN FREDERICKSON
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Credential | DO
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Telephone | 541-519-4250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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