Organization
SOUTHERN OREGON COLON AND RECTAL SURGICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD S NELSON DO (OWNER)
(541) 479-8308
Entity
Organization
Contact information
Practice address
520 SW RAMSEY AVE STE 204, GRANTS PASS, OR 97527-5535
(541) 479-8308
(541) 474-0447
Mailing address
520 SW RAMSEY AVE STE 204, GRANTS PASS, OR 97527-5535
(541) 479-8308
(541) 474-0447
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
DO29287
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
234880
—
OR
Enumeration date
09/15/2010
Last updated
10/14/2010
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