Individual
JOSE ILDEFONSO RODRIGUEZ MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2900 STATE ST STE 101, MEDFORD, OR 97504-8458
(541) 789-5790
Mailing address
2900 STATE ST STE 101, MEDFORD, OR 97504-8458
(541) 789-5790
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD202077
OR
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
267707
MA
Other
Enumeration date
07/14/2016
Last updated
07/14/2021
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