Individual
POLLY M SEPULVADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
150 NE KENNETH FORD DR, ROSEBURG, OR 97470-1042
(416) 729-5965
(541) 492-2060
Mailing address
573 NE STEPHENS ST, ROSEBURG, OR 97470-3150
(541) 677-2432
(541) 957-1131
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD16468
OR
207RR0500X
Rheumatology Physician
MD16468
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005129
—
OR
Enumeration date
11/03/2005
Last updated
12/09/2024
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