Provider Demographics
NPI:1912288671
Name:SOUTHERN OREGON NEUROSURGICAL & SPINE ASSOCIATES, PC
Entity Type:Organization
Organization Name:SOUTHERN OREGON NEUROSURGICAL & SPINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MIROSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-779-1672
Mailing Address - Street 1:2900 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8475
Mailing Address - Country:US
Mailing Address - Phone:541-779-1672
Mailing Address - Fax:541-779-0986
Practice Address - Street 1:2900 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8475
Practice Address - Country:US
Practice Address - Phone:541-779-1672
Practice Address - Fax:541-779-0986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty