Individual
JACQUELYN OUTCALT GROSHONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
201 MEDICAL LOOP RD, SUITE 170, ROSEBURG, OR 97471-8835
(541) 957-5437
(541) 464-5441
Mailing address
PO BOX 1700, ROSEBURG, OR 97470-0414
(541) 957-5437
(541) 464-5441
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD18388
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070511
—
OR
Enumeration date
08/02/2006
Last updated
09/10/2015
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