Organization
KIDSDOCS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN OUTCALT GROSHONG MD (PRESIDENT)
(541) 957-5437
Entity
Organization
Contact information
Practice address
201 NW MEDICAL LOOP, #170, ROSEBURG, OR 97471-8821
(541) 957-5437
(541) 464-5441
Mailing address
201 NW MEDICAL LOOP, #170, ROSEBURG, OR 97471-8821
(541) 957-5437
(541) 464-5441
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005908
—
OR
Enumeration date
08/02/2006
Last updated
11/04/2016
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