Individual
ANNA L USCHOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2900 STATE ST, MEDFORD, OR 97504-8475
(541) 779-1672
(541) 779-0986
Mailing address
2900 STATE ST, MEDFORD, OR 97504-8475
(541) 779-1672
(541) 779-0986
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3484
AZ
363AM0700X
Medical Physician Assistant
3484
AZ
363AS0400X
Surgical Physician Assistant
3484
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214517
—
AZ
01
—
P00618126
RR MEDICARE
AZ
Enumeration date
05/23/2007
Last updated
03/24/2014
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