Provider Demographics
NPI:1770014284
Name:ADVANCED JOINT REPLACEMENT CENTER OF SOUTHERN OREGON
Entity Type:Organization
Organization Name:ADVANCED JOINT REPLACEMENT CENTER OF SOUTHERN OREGON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YASER
Authorized Official - Middle Name:ABDEL-ALIM
Authorized Official - Last Name:METWALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-941-5133
Mailing Address - Street 1:707 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8425
Mailing Address - Country:US
Mailing Address - Phone:541-622-8900
Mailing Address - Fax:
Practice Address - Street 1:707 MURPHY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8425
Practice Address - Country:US
Practice Address - Phone:541-622-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-26
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23381207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty