Organization
SOUTHERN OREGON MEDICAL PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN DANIEL SPALLETTA (OWNER)
(541) 295-4034
Entity
Organization
Contact information
Practice address
824 UNIT B, ROGUE RIVER HIGHWAY, GRANTS PASS, OR 97527-0000
(541) 244-1261
(541) 295-8252
Mailing address
PO BOX 2552, GRANTS PASS, OR 97528-0213
(541) 295-4034
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1174571186
OR
Other
Enumeration date
08/07/2015
Last updated
08/07/2015
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