Deatherage, Mark F.
Deatherage, Mark F. is an individual health care provider with primary practice located at 1600 Nw 6Th St North Suite, Grants Pass OR 97526-1094. He recently has only one registered license in Allopathic & Osteopathic Physicians / Vascular Surgery, which is considered as his primary health care specialty. Deatherage, Mark F. can be contacted via phone (541) 474-5533.Contact Information
Primary practice address
1600 Nw 6Th St North Suite
Grants Pass OR 97526-1094
Phone: (541) 474-5533
Fax: (541) 476-2380
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Vascular Surgery | 2086S0129X | MD11842 | Oregon |
Profile Details
| NPI number | 1841293156 |
|---|---|
| LBN Legal business name | Deatherage, Mark F. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 31st, 2005 |
| Last updated | Oct 17th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841293156 | NPPES |
| Oregon | MEDICAID | 024059 |
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