Basic Information
| Provider Information | |||||||||
| NPI: | 1710169099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUNGERFORD | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | RYAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 DOCTORS PARK DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412822200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2900 DOCTORS PARK DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412822200 | ||||||||
| FaxNumber: | 5412105195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2007 | ||||||||
| LastUpdateDate: | 06/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | MD151028 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 500622687 | 05 | OR | MEDICAID |