Individual
JOHNATHAN T STILLWAGON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1026 N BERKELEY WAY UNIT 2MEDFORD, MEDFORD, OR 97504-6226
(458) 226-0017
Mailing address
1026 N BERKELEY WAY UNIT 2MEDFORD, MEDFORD, OR 97504-6226
(458) 226-0017
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
7958
OR
Other
Enumeration date
07/06/2026
Last updated
07/06/2026
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