Graduated: 2019
NPI: 1356977144
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES - OREGON
1111 CRATER LAKE AVE
MEDFORD, OR 975046241
5417325250
33 N CENTRAL AVE, SUITE 317
MEDFORD, OR 975015939
5412272808
Source: CMS National Downloadable File, September 2026.