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NPI Code Detail

MEDICARE: JON D PRULHIERE MD

MEDICARE: JON D PRULHIERE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianMD23533OR

General Provider Information

NPI Number : 1700857174
Entity Type Code : Individual
Provider Name (Legal Business Name) : JON D PRULHIERE MD
Provider Business Mailing Address
First Line : 1208 BEALL LN
Second Line :
City : CENTRAL POINT
State : OR
Zip : 97502-1573
Country : US
Telephone Number : 541-664-5151
Fax Number :
Provider Business Practice Location Address
First Line : 1200 MIRA MAR AVE
Second Line :
City : MEDFORD
State : OR
Zip : 97504-8546
Country : US
Telephone Number : 541-664-5151
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 11/26/2007

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