Provider Demographics
NPI:1952441594
Name:ALLERGY & ASTHMA CENTER OF SOUTHERN OREGON PC
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CENTER OF SOUTHERN OREGON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-858-1003
Mailing Address - Street 1:3860 CRATER LAKE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9741
Mailing Address - Country:US
Mailing Address - Phone:541-858-1003
Mailing Address - Fax:541-857-4499
Practice Address - Street 1:1722 WILLIAMS HWY
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5661
Practice Address - Country:US
Practice Address - Phone:541-858-1003
Practice Address - Fax:541-857-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty