Individual
JASON TAVAKOLIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 COBURG RD, EUGENE, OR 97401-2433
(541) 485-8111
(541) 342-6379
Mailing address
55 COBURG RD, EUGENE, OR 97401-2433
(541) 485-8111
(541) 342-6379
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD25760
OR
207XS0106X
Orthopaedic Hand Surgery Physician
MD25760
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023191
—
OR
01
—
P00317978
MC RAILROAD
OR
Enumeration date
07/29/2005
Last updated
12/27/2022
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