Provider Demographics
NPI:1861443186
Name:HEATHER A. KAHN, MD PC
Entity Type:Organization
Organization Name:HEATHER A. KAHN, MD PC
Other - Org Name:ROGUE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-244-2197
Mailing Address - Street 1:702 SW RAMSEY AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527
Mailing Address - Country:US
Mailing Address - Phone:541-244-2197
Mailing Address - Fax:541-295-3057
Practice Address - Street 1:702 SW RAMSEY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527
Practice Address - Country:US
Practice Address - Phone:541-244-2197
Practice Address - Fax:541-295-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR121605Medicare ID - Type UnspecifiedMEDICARE ID NUMBER