Basic Information
| Provider Information | |||||||||
| NPI: | 1790910628 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOROSH | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4749 | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975010227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417894111 | ||||||||
| FaxNumber: | 5417895518 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 MAPLE STREET | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975201552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412014000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2009 | ||||||||
| LastUpdateDate: | 01/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 4301 094 181 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD201607 | OR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | ME142519 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 56902 | WI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.