Provider Demographics
NPI:1912960477
Name:HECOX, KERRI ANN (MD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:ANN
Last Name:HECOX
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 1:1025 E MAIN ST STE 108
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7448
Mailing Address - Country:US
Mailing Address - Phone:541-200-1530
Mailing Address - Fax:541-772-0284
Practice Address - Street 1:1025 E MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7448
Practice Address - Country:US
Practice Address - Phone:541-618-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022868Medicaid
943096772OtherFEDERAL TAX ID
132429Medicare ID - Type Unspecified
943096772OtherFEDERAL TAX ID