Individual
KEERTI JAINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD171157
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
NORTH BEND MEDICAL CENTER GROUP NPI
OR
01
—
161133
NORTH BEND MEDICAL CENTER GROUP MEDICAID
OR
05
—
500688655
—
OR
01
—
93-0635514
NORTH BEND MEDICAL CENTER GROUP TAX ID
OR
01
—
R0000WFBTV
NORTH BEND MEDICAL CENTER GROUP MEDICARE
OR
Enumeration date
07/02/2012
Last updated
07/30/2015
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