Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | DO186862 | OR |
NPI | 1013259167 |
---|---|
Provider Name | Dr. Justin Matthew Spaulding |
First Address | Medford, OR 97504-8279 |
Second Address | Medford, OR 97504-8279 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2013 |
Last Update Date | 18/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500743468 | (05) | OR |