Frederic J Van Dis MD

NPI 1093786261 - Specialist - 174400000X

NPI Details
NPI 1093786261
Gender Male
Enumeration Date 01/27/2006
Last Updated 03/10/2016
Entity Type Individual
Active Over 10 years ago
Practice Location
2801 NW MERCY DR
STE. 300
ROSEBURG OR, 97471-2348, US
Phone (541) 677-1555
Fax (541) 677-6543
Business Location
2801 NW MERCY DR
STE. 340
ROSEBURG OR, 97471-2348, US
Phone (541) 677-4319
Fax (541) 677-6140
Toxanomy
Taxonomy Code 174400000X
License State Oregon
License Number MD12356
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According to our database, Dr. Frederic J Van Dis MD NPI is 1093786261, taxonomy code is 174400000X and license number is MD12356, license state is located at Oregon. Frederic J Van Dis MD physically located at 2801 Nw Mercy Dr, Roseburg OR, 97471-2348. NPI Number Frederic J Van Dis MD has the Individual type.

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1093786261 NPI number is provided on an as is basis without warranty of any kind. 1093786261 is maintained by the National Plan & Provider Enumeration System. The contents of Frederic J Van Dis MD are for informational purposes only.