# SOUTHERN OREGON EAR NOSE & THROAT P C

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

## Provider details

- **NPI number:** 1821274317
- **Authorized official:** MRS. CINDI S BOUCHER (OFFICE MANAGER)
- **Authorized official phone:** (541) 734-3610

## Contact information

- **Practice address:** 555 BLACK OAK DR STE 210, MEDFORD, OR 97504-8491
- **Practice address phone:** (541) 734-3540
- **Mailing address:** 555 BLACK OAK DR STE 210, MEDFORD, OR 97504-8491
- **Mailing address phone:** (541) 734-3540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | MD17390 | OR | Yes |

## Other

- **Enumeration date:** 01/14/2008
- **Last updated:** 03/10/2022