Organization
SISKIYOU VITAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY MCCLANE DUNCAN ND (OWNER/MEMBER)
(541) 210-5687
Entity
Organization
Contact information
Practice address
940 ELLENDALE DR # 102, MEDFORD, OR 97504-8216
(541) 210-5687
(541) 392-4962
Mailing address
940 ELLENDALE DR # 102, MEDFORD, OR 97504-8216
(541) 210-5687
(541) 392-4962
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
12/15/2020
Last updated
12/15/2020
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