Basic Information
| Provider Information | |||||||||
| NPI: | 1568555001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMAHON | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2620 EAST BARNETT RD SUITE H | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417894281 | ||||||||
| FaxNumber: | 5417895538 | ||||||||
| Practice Location | |||||||||
| Address1: | 2841 AVENUE G, SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | WHITE CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975033030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418265252 | ||||||||
| FaxNumber: | 5416085785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 05/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DO19768 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4002804-02 | 01 | OR | REGENCE PC 65 | OTHER | H2549-02 | 01 | OR | PACIFIC SOURCE | OTHER | 0237420-02 | 01 | OR | REGENCE BLUE CROSS OF OR | OTHER | 079587 | 05 | OR | MEDICAID | 122912 | 01 | OR | DEPT OF LABOR WORK COMP | OTHER |