Organization
SOUTHERN OREGON FOOT & ANKLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN CHARD MERRILL DPM (OWNER)
(541) 776-3338
Entity
Organization
Contact information
Practice address
1904 E BARNETT RD, MEDFORD, OR 97504-8262
(541) 776-3338
(541) 776-4979
Mailing address
1904 E BARNETT RD, MEDFORD, OR 97504-8262
(541) 776-3338
(541) 776-4979
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
243148
—
OR
01
—
891269000
BLUE CROSS GROUP #
OR
Enumeration date
09/06/2007
Last updated
09/16/2020
Update your record
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