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General NPI Number Information
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NPI Number | 1891980546
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Entity Type | Organization
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Legal Business Name | SOUTHERN OREGON FOOT & ANKLE, LLC
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 1904 E BARNETT RD
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City | MEDFORD
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State | OR
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Zip | 97504-8262
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Country | US
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Telephone | 541-776-3338
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Fax | 541-776-4979
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Provider Business Mailing Address
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Address Line | 1904 E BARNETT RD
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City | MEDFORD
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State | OR
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Zip | 97504-8262
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Country | US
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Telephone | 541-776-3338
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Fax | 541-776-4979
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Authorized Official
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Title or Position | OWNER
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Name | EVAN CHARD MERRILL
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Credential | DPM
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Telephone | 541-776-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number |
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License Number State |
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