Organization
MEDFORD FOOT & ANKLE CLINIC, PC
Active
Organization
MEDFORD FOOT & ANKLE CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL ANDREW DEKORTE DPM (OFFICER PRESIDENT)
(541) 770-1225
Entity
Organization
Contact information
Practice address
713 GOLF VIEW DRIVE, MEDFORD, OR 97504-9643
(541) 770-1225
(541) 770-1245
Mailing address
713 GOLF VIEW DRIVE, MEDFORD, OR 97504-9643
(541) 770-1225
(541) 770-1245
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023677000
REGENCE BC
OR
05
—
240546
—
OR
Enumeration date
09/26/2006
Last updated
01/05/2021
Update your record
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