Organization
CENTENNIAL MEDICAL GROUP, INC
Active
Other names
DBA Roseburg Urology
Organization subpart
No
Provider details
NPI number
Authorized official
JASON GRAY MD (PRESIDENT)
(541) 677-2494
Entity
Organization
Contact information
Practice address
2460 NW STEWART PARKWAY,, SUITE 100, ROSEBURG, OR 97471
(541) 677-6141
(541) 677-6143
Mailing address
P.O. BOX 910, ROSEBURG, OR 97470
(541) 677-6141
(541) 677-6143
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
497634-93
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171678
—
OR
Enumeration date
02/25/2008
Last updated
04/04/2012
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