Individual
THEODORE CHARLES WOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2825 E BARNETT RD, MEDFORD, OR 97504-8332
(541) 789-7000
Mailing address
24 EMERICK ST, ASHLAND, OR 97520-2066
(541) 591-5934
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10003883
OR
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
01/09/2023
Last updated
02/02/2023
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