Organization
CENTENNIAL MEDICAL GROUP WEST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS KLEBE (OFFICER)
(541) 677-3650
Entity
Organization
Contact information
Practice address
2801 NW MERCY DR., STE. 340, ROSEBURG, OR 97471
(541) 677-4319
(541) 677-2294
Mailing address
2801 NW MERCY DR., STE. 340, ROSEBURG, OR 97471
(541) 677-4319
(541) 677-2294
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500626861
—
OR
Enumeration date
09/03/2010
Last updated
03/07/2017
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