Individual
DR. CORY FAWCETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 NW 6TH ST, NORTH SUITE, GRANTS PASS, OR 97526-1094
(541) 474-5533
(541) 476-2380
Mailing address
1600 NW 6TH ST, NORTH SUITE, GRANTS PASS, OR 97526-1094
(541) 474-5533
(541) 476-2380
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
G68483
CA
208600000X
Surgery Physician
Primary
MD18198
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057047
—
OR
Enumeration date
05/31/2005
Last updated
02/20/2013
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