# WILD ROSE MEDICAL CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083762637
- **Authorized official:** KATHLEEN CORDES MD (PRESIDENT)
- **Authorized official phone:** (541) 686-4153

## Contact information

- **Practice address:** 401 E 10TH AVE, SUITE 250, EUGENE, OR 97401-3317
- **Practice address phone:** (541) 686-4153
- **Practice address fax:** (541) 686-3468
- **Mailing address:** 401 E 10TH AVE, SUITE 250, EUGENE, OR 97401-3317
- **Mailing address phone:** (541) 686-4153
- **Mailing address fax:** (541) 686-3468

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 16009 | OR | Yes |

## Other

- **Enumeration date:** 01/08/2007
- **Last updated:** 10/10/2007