Active NPI 1134167182 Individual Practitioner Female Practitioner

Dr. Jeri Kersten Mendelson , MD

Specialist • Medford, OR

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Jeri Mendelson, MD is a certified Specialist practicing in Medford, OR. With approximately 28 years of clinical experience since graduating from University Of Arkansas College Of Medicine in 1998, Dr. Mendelson delivers high-quality medical care to the local community at 3210 HILLCREST PARK DR STE 100.

Dr. Mendelson accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, destruction of skin growth. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

3210 Hillcrest Park Dr Ste 100

Medford, OR 975047687

Telephone 5417720278

Fax 5417720151

Associated Practice Facility / Clinic

🏢 Roxyann Dermatology, Llc Facility NPI 1699392985

Medicare Profile & Education

Medical School

University Of Arkansas College Of Medicine

Graduation Year

1998

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Specialist in Medford, OR

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

28 Yrs +2.3 yrs vs City Avg

City Avg: 25.7 Yrs

State Avg: 35.7 Yrs

Regional Practice Density

38 Specialists

Practicing in Medford, OR (1153 Statewide)

Telehealth Adoption Rate

23.7% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

66.3% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Mendelson (28 Years) 28 Yrs

Medford Specialty Average (25.7 Years) 25.7 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,088	393	$20.76	$6.74
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,132	1,046	$396.37	$127.62
17000 Destruction of skin growth	749	599	$209.94	$57.13
17110 Destruction of up to 14 skin growths	380	352	$353.62	$109.03
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	308	254	$174.87	$56.42
99213 Established patient office or other outpatient visit, typically 15 minutes	236	203	$280.95	$90.48
88305 Pathology examination of tissue using a microscope, intermediate complexity	209	144	$112.00	$36.49
17004 Destruction of precancer skin growth, 15 or more growths	75	56	$518.40	$168.10
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	53	43	$421.05	$128.80
96574 Application of light with debridement to destroy precancer skin growth	51	37	$862.09	$279.37
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	51	37	$592.08	$383.60
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	44	42	$422.80	$127.74
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	41	35	$480.35	$154.17
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	29	26	$428.13	$131.72
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	23	23	$375.61	$103.36
17111 Destruction of skin growth, 15 or more growths	17	14	$412.98	$134.52
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	15	15	$514.90	$157.04
11102 Tangential biopsy of single skin lesion	15	15	$311.11	$90.49
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	13	13	$379.16	$108.69

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,639	487	$20.43	$6.60
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,253	1,127	$385.73	$124.20
17000 Destruction of skin growth	809	650	$203.68	$53.54
17110 Destruction of up to 14 skin growths	426	379	$345.60	$106.47
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	324	260	$170.53	$54.99
88305 Pathology examination of tissue using a microscope, intermediate complexity	242	173	$112.00	$36.05
99213 Established patient office or other outpatient visit, typically 15 minutes	158	148	$272.51	$87.72
17004 Destruction of precancer skin growth, 15 or more growths	117	89	$512.41	$165.72
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	58	51	$418.63	$128.30
96574 Application of light with debridement to destroy precancer skin growth	49	38	$857.08	$277.17
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	49	38	$586.33	$384.63
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	45	40	$417.07	$127.36
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	41	39	$371.50	$111.60
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	37	37	$501.24	$162.02
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	35	31	$475.65	$151.63
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	27	23	$424.53	$130.14
17111 Destruction of skin growth, 15 or more growths	22	17	$403.20	$130.40
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	12	11	$374.76	$106.05
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	11	11	$336.74	$108.82
11102 Tangential biopsy of single skin lesion	11	11	$308.95	$81.75

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,626	459	$20.11	$6.54
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,261	1,145	$378.37	$122.94
17000 Destruction of skin growth	843	696	$198.24	$53.35
17110 Destruction of up to 14 skin growths	431	389	$335.53	$105.05
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	326	277	$165.93	$54.05
88305 Pathology examination of tissue using a microscope, intermediate complexity	246	180	$111.20	$36.21
99213 Established patient office or other outpatient visit, typically 15 minutes	181	160	$267.41	$87.31
17004 Destruction of precancer skin growth, 15 or more growths	109	85	$499.61	$163.19
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	77	77	$491.32	$160.67
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	62	52	$412.75	$123.83
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	49	39	$588.35	$389.03
96574 Application of light with debridement to destroy precancer skin growth	49	39	$850.08	$277.88
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	48	48	$410.04	$124.82
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	39	34	$464.42	$147.90
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	27	25	$365.05	$106.09
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	25	22	$420.54	$128.93
17111 Destruction of skin growth, 15 or more growths	19	16	$392.85	$128.01
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	17	17	$367.37	$112.97
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	16	16	$328.69	$103.70
99202 New patient office or other outpatient visit, typically 20 minutes	15	15	$214.07	$70.06
11102 Tangential biopsy of single skin lesion	14	13	$303.92	$95.75

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,871	512	$19.18	$6.33
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,447	1,241	$378.51	$124.55
17000 Destruction of skin growth	929	758	$193.21	$51.73
17110 Destruction of up to 14 skin growths	471	416	$332.60	$103.73
88305 Pathology examination of tissue using a microscope, intermediate complexity	414	282	$111.08	$36.81
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	261	226	$163.89	$54.23
99213 Established patient office or other outpatient visit, typically 15 minutes	227	206	$265.87	$88.21
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	176	176	$488.79	$159.65
17004 Destruction of precancer skin growth, 15 or more growths	133	96	$484.27	$160.93
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	82	65	$416.90	$120.75
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	65	63	$410.35	$127.71
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	64	60	$365.12	$108.04
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	48	37	$584.74	$389.83
17111 Destruction of skin growth, 15 or more growths	46	36	$389.52	$119.20
96574 Application of light with debridement to destroy precancer skin growth	46	36	$848.09	$281.83
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	43	38	$468.62	$155.70
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	39	32	$425.51	$132.34
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	36	36	$367.51	$111.91
11102 Tangential biopsy of single skin lesion	34	33	$304.87	$84.91
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	33	33	$326.55	$106.15
99202 New patient office or other outpatient visit, typically 20 minutes	29	29	$212.08	$70.48
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	17	16	$302.95	$65.04

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,346	472	$19.59	$5.88
99213 Established patient office or other outpatient visit, typically 15 minutes	1,240	1,106	$247.28	$73.07
17000 Destruction of skin growth	768	654	$212.03	$51.18
88305 Pathology examination of tissue using a microscope, intermediate complexity	426	299	$218.60	$64.09
17110 Destruction of up to 14 skin growths	361	331	$365.98	$101.32
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	253	253	$310.81	$106.61
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	239	216	$152.05	$43.93
17004 Destruction of precancer skin growth, 15 or more growths	141	111	$516.39	$153.90
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	66	58	$682.54	$189.44
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	64	59	$593.11	$159.56
96900 Application of ultraviolet light to skin	58	12	$70.45	$21.50
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	56	56	$367.52	$105.01
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	51	48	$401.97	$111.46
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	39	36	$460.22	$127.50
11102 Tangential biopsy of single skin lesion	38	36	$305.63	$87.85
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	30	28	$634.71	$161.97
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	26	22	$416.08	$376.07
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	23	22	$402.26	$129.11
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	22	22	$452.28	$131.16
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	20	20	$505.50	$143.93
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	19	18	$380.96	$93.66
99202 New patient office or other outpatient visit, typically 20 minutes	19	19	$263.37	$73.89
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	15	14	$588.80	$163.39
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	13	13	$400.59	$111.63
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	12	12	$349.35	$89.89

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,821	539	$16.00	$5.44
99213 Established patient office or other outpatient visit, typically 15 minutes	1,764	1,484	$198.19	$72.13
17000 Destruction of skin growth	899	749	$177.01	$52.44
88305 Pathology examination of tissue using a microscope, intermediate complexity	432	304	$190.00	$67.37
17110 Destruction of up to 14 skin growths	430	379	$298.79	$100.65
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	318	277	$119.27	$43.78
17004 Destruction of precancer skin growth, 15 or more growths	187	140	$395.00	$148.14
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	92	76	$475.61	$155.96
96900 Application of ultraviolet light to skin	81	13	$57.32	$20.61
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	66	66	$289.73	$105.64
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	65	54	$551.15	$188.70
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	57	52	$323.47	$108.97
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	56	11	$306.07	$111.00
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	43	42	$344.84	$126.77
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	42	39	$350.00	$338.01
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	40	39	$355.00	$120.45
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	30	28	$506.33	$164.95
99202 New patient office or other outpatient visit, typically 20 minutes	27	27	$203.00	$71.24
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	26	25	$379.58	$131.74
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	20	20	$479.65	$162.15
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	19	18	$308.32	$95.40
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	16	16	$432.00	$145.65
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	16	14	$518.25	$158.88
11102 Tangential biopsy of single skin lesion	12	12	$271.92	$76.95
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	11	11	$264.73	$78.01

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,793	567	$15.90	$4.95
99213 Established patient office or other outpatient visit, typically 15 minutes	1,792	1,532	$191.35	$69.05
17000 Destruction of skin growth	917	775	$174.47	$50.41
88305 Pathology examination of tissue using a microscope, intermediate complexity	514	346	$190.17	$65.14
17110 Destruction of up to 14 skin growths	402	373	$295.00	$98.88
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	312	278	$114.51	$41.36
17004 Destruction of precancer skin growth, 15 or more growths	174	135	$393.97	$135.29
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	99	80	$538.89	$182.30
96900 Application of ultraviolet light to skin	93	12	$54.72	$19.45
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	85	73	$463.66	$146.53
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	63	63	$282.86	$102.47
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	63	61	$295.43	$97.92
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	61	59	$317.18	$106.57
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	41	36	$493.05	$162.16
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	41	40	$352.59	$106.48
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	41	13	$293.24	$106.57
11100 Biopsy of single growth of skin and/or tissue	30	28	$277.50	$85.46
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	28	25	$350.00	$333.94
99202 New patient office or other outpatient visit, typically 20 minutes	28	28	$195.25	$71.40
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	26	24	$424.27	$129.22
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	24	24	$373.50	$128.66
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	24	24	$472.00	$162.13
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	18	18	$301.44	$93.28
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	12	12	$378.67	$132.30

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,873	555	$17.39	$5.42
99213 Established patient office or other outpatient visit, typically 15 minutes	1,883	1,533	$181.32	$70.75
17000 Destruction of skin growth	963	778	$174.35	$53.64
88305 Pathology examination of tissue using a microscope, intermediate complexity	533	370	$199.25	$66.75
17110 Destruction of up to 14 skin growths	402	367	$277.18	$100.66
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	391	338	$108.71	$42.31
17004 Destruction of precancer skin growth, 15 or more growths	176	118	$384.16	$144.69
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	98	18	$172.92	$68.60
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	96	82	$439.54	$156.16
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	78	66	$507.87	$193.18
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	69	63	$297.57	$107.83
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	69	64	$278.78	$100.34
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	59	59	$267.98	$103.73
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	58	44	$463.28	$164.94
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	39	38	$353.67	$130.74
99202 New patient office or other outpatient visit, typically 20 minutes	31	31	$184.97	$72.96
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	30	24	$350.00	$343.55
11100 Biopsy of single growth of skin and/or tissue	26	25	$257.77	$94.42
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	25	24	$323.84	$130.62
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	21	21	$450.14	$164.45
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	17	17	$401.88	$151.63
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	15	14	$303.40	$103.44
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	14	14	$244.57	$84.91

Medical Specialties & State Licenses

CMS Verified: 2020-10-23

Specialist Primary Specialty

NUCC Taxonomy Code: 174400000X

State License OR MD24092

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

226802 (OR)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events

📍

Updated Practice Location October 23, 2020

Registered at 3210 HILLCREST PARK DR STE 100, MEDFORD, OR 975047687 (Tel: 5417720278)

📍

Updated Business Mailing Address October 23, 2020

Registered at 3210 HILLCREST PARK DR STE 100, MEDFORD, OR 975047687 (Tel: 5417720278)

✅

NPI Profile Active April 22, 2010

NPI status registered as active in NPPES database

📍

Updated Practice Location April 22, 2010

Registered at 2959 SISKIYOU BLVD, #B, MEDFORD, OR 975049037 (Tel: 5417733636)

📍

Updated Business Mailing Address April 22, 2010

Registered at 2959 SISKIYOU BLVE, #B, MEDFORD, OR 975049037 (Tel: 5417733636)

👤

Provider Name / Credentials Updated April 22, 2010

Recorded as JERI MENDELSON, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) April 22, 2010

Specialist (License #MD24092 in OR)

🟢

Initial NPI Registration & Enumeration June 03, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1134167182

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: June 03, 2006

Last Update: October 23, 2020

Sole Proprietor: No

Update or Correct Profile

Mailing Address

3210 Hillcrest Park Dr Ste 100

Medford, OR 975047687

Phone: 5417720278

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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