Van Dis, Frederic J
Van Dis, Frederic J is an individual health care provider with primary practice located at 2801 Nw Mercy Dr Ste. 300, Roseburg OR 97471. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Van Dis, Frederic J can be contacted via phone (541) 677-1555.Contact Information
Primary practice address
2801 Nw Mercy Dr Ste. 300
Roseburg OR 97471
Phone: (541) 677-1555
Fax: (541) 677-6543
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | MD12356 | Oregon |
Profile Details
| NPI number | 1093786261 |
|---|---|
| LBN Legal business name | Van Dis, Frederic J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 27th, 2006 |
| Last updated | May 26th, 2020 - about 4 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 | 1093786261 | NPPES |
| Oregon | Other | 060070869 | RAILROAD MEDICARE |
| Oregon | Other | MD12356 | RAILROAD MEDICARE |
| Oregon | MEDICAID | 114173 | RAILROAD MEDICARE |
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