Individual
JENNIFER W CHILDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3156 STATE ST, MEDFORD, OR 97504-8450
(541) 773-9772
(541) 773-9772
Mailing address
3156 STATE ST, MEDFORD, OR 97504-8450
(541) 773-9772
(541) 773-9772
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD17352
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500608995
—
OR
Enumeration date
10/23/2006
Last updated
12/16/2011
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