Organization
EVERGREEN REGENERATIVE MEDICINE AND REHABILITATION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID E HARRIS (PRESIDENT/OWNER)
(541) 414-0455
Entity
Organization
Contact information
Practice address
707 MURPHY RD, MEDFORD, OR 97504-8520
(541) 414-0455
(541) 414-0450
Mailing address
707 MURPHY RD STE 101, MEDFORD, OR 97504-8520
(541) 414-0455
(541) 414-0450
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500679386
—
OR
Enumeration date
10/07/2021
Last updated
12/05/2021
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