Graduated: 2019
NPI: 1386227031
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES - OREGON
1111 CRATER LAKE AVE
MEDFORD, OR 975046241
5417325250
PROVIDENCE HEALTH AND SERVICES OREGON
1111 CRATER LAKE AVE
MEDFORD, OR 975046241
5417325545
Source: CMS National Downloadable File, September 2026.