Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD15974 | OR |
NPI | 1184759169 |
---|---|
Provider Name | Joan Murray Rote |
First Address | Medford, OR 97504-8497 |
Second Address | Medford, OR 97504-8497 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 13/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
072165 | (05) | OR |
C02554 | (02) | OR |