Basic Information
| Provider Information | |||||||||
| NPI: | 1568598860 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TELFORD | ||||||||
| FirstName: | BYRON | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2620 EAST BARNETT RD | ||||||||
| Address2: | SUITE H | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417895250 | ||||||||
| FaxNumber: | 5417895538 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 BLACK OAK DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414942000 | ||||||||
| FaxNumber: | 5414942002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 04/26/2013 | ||||||||
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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 | 363L00000X | 200050100NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 000483 | 05 | OR | MEDICAID |