Groshong, Jacquelyn Outcalt

Groshong, Jacquelyn Outcalt is an individual health care provider with primary practice located at 201 Medical Loop Rd Suite 170, Roseburg OR 97471-8835. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Groshong, Jacquelyn Outcalt can be contacted via phone (541) 957-5437.

Contact Information

Primary practice address
201 Medical Loop Rd Suite 170 Roseburg OR 97471-8835
Phone: (541) 957-5437
Fax: (541) 464-5441
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD18388 Oregon

Profile Details

NPI number 1700893674
LBN Legal business name Groshong, Jacquelyn Outcalt
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 2nd, 2006
Last updated Sep 10th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700893674 NPPES
Oregon MEDICAID 070511

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