Provider Demographics
NPI:1093974107
Name:GERALD A. JAWORSKI, M.D., P.C.
Entity Type:Organization
Organization Name:GERALD A. JAWORSKI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JAWORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-673-0609
Mailing Address - Street 1:2282 NW TROOST ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-6072
Mailing Address - Country:US
Mailing Address - Phone:541-673-0609
Mailing Address - Fax:541-440-9387
Practice Address - Street 1:2282 NW TROOST ST STE 101
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-6072
Practice Address - Country:US
Practice Address - Phone:541-673-0609
Practice Address - Fax:541-440-9387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty