Organization
TWO RIVERS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN BRUCE STOUT M.D. (OWNER-PHYSICIAN)
(541) 484-4339
Entity
Organization
Contact information
Practice address
995 WILLAGILLESPIE, STE 200A, EUGENE, OR 97401
(541) 484-4339
Mailing address
1941 POTTER STREET, EUGENE, OR 97401-3059
(541) 485-9534
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD15846
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027565
—
OR
Enumeration date
03/08/2007
Last updated
08/22/2020
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