Individual
JEREMY WADE ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
965 ELLENDALE DR, MEDFORD, OR 97504-8215
(541) 732-6000
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 732-7950
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA169124
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500674465
—
OR
Enumeration date
07/28/2014
Last updated
05/03/2022
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