Organization
ROGUE VALLEY PHYSICIANS PC
Active
Parent organization
ROGUE VALLEY PHYSICIANS PC
Other names
FAMILY PRACTICE GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
ROGUE VALLEY PHYSICIANS PC
Authorized official
VICKI WAGNER (CEO)
(541) 282-8817
Entity
Organization
Contact information
Practice address
229 W STEWART AVE, MEDFORD, OR 97501-3663
(541) 282-8808
(541) 681-6452
Mailing address
2900 DOCTORS PARK DR, SUITE 250, MEDFORD, OR 97504-8198
(541) 282-2208
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207VG0400X
Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218621
—
OR
Enumeration date
04/10/2008
Last updated
06/03/2008
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