Provider Demographics
NPI:1508816794
Name:SOUTHERN OREGON HOSPITALISTS PC
Entity Type:Organization
Organization Name:SOUTHERN OREGON HOSPITALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-282-6770
Mailing Address - Street 1:2640 E BARNETT RD
Mailing Address - Street 2:E333
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4301
Mailing Address - Country:US
Mailing Address - Phone:541-282-6770
Mailing Address - Fax:541-282-6771
Practice Address - Street 1:2825 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8332
Practice Address - Country:US
Practice Address - Phone:541-282-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR206311-95208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR130940Medicare PIN