# MEDFORD MEDICAL CLINIC, LLP

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

## Provider details

- **NPI number:** 1366449662
- **Authorized official:** MR. JON KANE VANVALKENBURG M.D. (PARTNER)
- **Authorized official phone:** (541) 734-3430

## Contact information

- **Practice address:** 555 BLACK OAK DR, SUITE 100, MEDFORD, OR 97504-8447
- **Practice address phone:** (541) 734-3430
- **Practice address fax:** (541) 734-3666
- **Mailing address:** PO BOX 7841, BELFAST, ME 04915-7800
- **Mailing address phone:** (541) 734-3430
- **Mailing address fax:** (541) 734-3666

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD21703 | OR | Yes |
| 207Q00000X | Family Medicine Physician | — | OR | — |
| 207R00000X | Internal Medicine Physician | — | OR | — |
| 363L00000X | Nurse Practitioner | — | OR | — |

## Other

- **Enumeration date:** 06/30/2005
- **Last updated:** 05/06/2014