Individual
DR. MARK F. DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 NW 6TH ST, NORTH SUITE, GRANTS PASS, OR 97526-1094
(541) 474-5533
(541) 476-2380
Mailing address
1600 NW 6TH ST, NORTH SUITE, GRANTS PASS, OR 97526-1094
(541) 474-5533
(541) 476-2380
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
MD11842
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024059
—
OR
Enumeration date
05/31/2005
Last updated
10/17/2012
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