Individual
AUTUMN POLIDOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
19 MYRTLE ST, MEDFORD, OR 97504-7337
(543) 773-3863
(541) 776-2892
Mailing address
1221 DISK DR, MEDFORD, OR 97501-6638
(541) 773-3863
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD184735
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2014
Last updated
11/15/2024
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