Basic Information
| Provider Information | |||||||||
| NPI: | 1366492548 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JON E. L. ERMSHAR, MD, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WELLSPRING FAMILY PRACTICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1208 BEALL LN | ||||||||
| Address2: | |||||||||
| City: | CENTRAL POINT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975021573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416645151 | ||||||||
| FaxNumber: | 5416645155 | ||||||||
| Practice Location | |||||||||
| Address1: | 1716 WILLIAMS HWY | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975275661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414746053 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 11/26/2007 | ||||||||
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| AuthorizedOfficialLastName: | ERMSHAR | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 5414746053 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.