Provider Demographics
NPI:1578566691
Name:PADEN, PHILIP Y (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:Y
Last Name:PADEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:221 W STEWART AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3647
Mailing Address - Country:US
Mailing Address - Phone:541-776-9026
Mailing Address - Fax:541-776-9096
Practice Address - Street 1:221 W STEWART AVE
Practice Address - Street 2:STE 110
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3647
Practice Address - Country:US
Practice Address - Phone:541-776-9026
Practice Address - Fax:541-776-9096
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR13653207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR183905Medicaid
D7303Medicare UPIN
OR112567Medicare ID - Type Unspecified