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Individual

REVAZ BOUKIA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
280 MAPLE ST, ASHLAND, OR 97520-1552
(541) 201-4000
(541) 488-7437
Mailing address
2825 E BARNETT RD, MSS, MEDFORD, OR 97504-8332
(541) 789-4281
(541) 789-4806

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA228829
OR
363A00000X
Physician Assistant
Primary

Other

Enumeration date
07/25/2014
Last updated
05/06/2026
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