Provider Demographics
NPI:1982915344
Name:AUFDERHEIDE, ADAM CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:CHRISTOPHER
Last Name:AUFDERHEIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 YALE DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9736
Mailing Address - Country:US
Mailing Address - Phone:541-842-2020
Mailing Address - Fax:541-842-2022
Practice Address - Street 1:748 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8473
Practice Address - Country:US
Practice Address - Phone:541-842-2020
Practice Address - Fax:541-842-2022
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51281207W00000X
KS9407515207W00000X
ORMD176895207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD176895OtherOREGON MEDICAL LICENSE