Provider Demographics
NPI:1336226927
Name:DEMIAN, PAMELA GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:GRACE
Last Name:DEMIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:CLARK
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,
Mailing Address - Street 1:1245 N RIVERSIDE AVE STE 23
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-4655
Mailing Address - Country:US
Mailing Address - Phone:541-414-0330
Mailing Address - Fax:541-414-0333
Practice Address - Street 1:1245 N RIVERSIDE AVE STE 23
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-4655
Practice Address - Country:US
Practice Address - Phone:541-414-0330
Practice Address - Fax:541-414-0333
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD187777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD18777OtherOREGON MEDICAL LICENSE
ORMD18777OtherOREGON MEDICAL LICENSE