Provider Demographics
NPI:1134167182
Name:MENDELSON, JERI KERSTEN (MD)
Entity type:Individual
Prefix:DR
First Name:JERI
Middle Name:KERSTEN
Last Name:MENDELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 HILLCREST PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7687
Mailing Address - Country:US
Mailing Address - Phone:541-772-0278
Mailing Address - Fax:541-772-0151
Practice Address - Street 1:3210 HILLCREST PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7687
Practice Address - Country:US
Practice Address - Phone:541-772-0278
Practice Address - Fax:541-772-0151
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24092174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226802Medicaid
OR070017477Medicare PIN
OR226802Medicaid
OR114523Medicare ID - Type UnspecifiedMEDICARE