Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D8296 | OR |
NPI | 1003913906 |
---|---|
Provider Name | Dr. Jeffrey M Mulford |
First Address | Eugene, OR 97405-2989 |
Second Address | Eugene, OR 97405-2989 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |