Provider Demographics
NPI:1396714515
Name:RADIATION ONCOLOGY GROUP CONSULTANTS, PC
Entity type:Organization
Organization Name:RADIATION ONCOLOGY GROUP CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDEFUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-772-0023
Mailing Address - Street 1:PO BOX 8509
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-5009
Mailing Address - Country:US
Mailing Address - Phone:541-772-0023
Mailing Address - Fax:
Practice Address - Street 1:2825 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8332
Practice Address - Country:US
Practice Address - Phone:541-772-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR247679Medicaid
ORR0000WCJXCMedicare PIN