Provider Demographics
NPI:1669460697
Name:VERSTEEG, CHARLES NEIL JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:NEIL
Last Name:VERSTEEG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 E BARNETT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8343
Mailing Address - Country:US
Mailing Address - Phone:541-779-6250
Mailing Address - Fax:541-608-2535
Practice Address - Street 1:2780 E BARNETT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8343
Practice Address - Country:US
Practice Address - Phone:541-779-6250
Practice Address - Fax:541-608-2535
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12820207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR238055Medicaid
00WCGKNKMedicare ID - Type Unspecified
OR238055Medicaid