LARRY JOU MAUKONEN (NPI# 1912963661) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912963661 |
| Entity Type | Individual |
| Full Name | LARRY JOU MAUKONEN |
| Credential | MD |
| Practice Address |
897 Royal Ave Suite B Medford OR 97504 |
| Practice Telephone | 5417794991 |
| Practice Fax Number | 5417722910 |
| Mailing Telephone | 5417794991 |
| Mailing Fax Number | 5417722910 |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD09549 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 239939 | 05 |
| Street Address |
897 ROYAL AVE SUITE B |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164642682 | Southern Oregon Neurology PC | Psychiatry & Neurology | 897 Royal Ave, Ste B, Medford, OR 97504-6121 | 2007-04-26 |
| 1104991405 | Northwest Pain Management Inc | Clinic/Center | 897 Royal Ave, Suite C, Medford, OR 97504-6121 | 2006-11-21 |
| 1821054578 | John Anderson Melson | Psychiatry & Neurology | 897 Royal Ave, Ste B, Medford, OR 97504 | 2006-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659519767 | Cynthia Shearn Tainsh | Psychiatry & Neurology | 97 Westwood Rd, Medford, MA 02155-1637 | 2009-01-27 |
| 1528217460 | Christopher Dardis | Psychiatry & Neurology | 2900 State St Ste 101, Medford, OR 97504-8458 | 2008-09-16 |
| 1225249675 | Bruce Ehrenberg | Psychiatry & Neurology | 4 Colby St, Medford, MA 02155-6013 | 2007-05-25 |
| 1366658627 | Nishant Singh Ranawat | Psychiatry & Neurology | Asante Rogue Regional Medical Center, 2825 E Barnett Road, Medford, OR 97504 | 2007-05-15 |
| 1922143296 | Eugenia Blank | Psychiatry & Neurology | 170 Governors Ave Ste 258, Medford, MA 02155-1643 | 2007-02-21 |
| 1265416317 | South Jersey Neurocare Pa | Psychiatry & Neurology | 520 Stokes Rd, Suite A-4, Medford, NJ 08055-2904 | 2005-12-02 |
| 1063412427 | Oscar Adolfo Sanchez | Psychiatry & Neurology | 520 Medical Center Drive, Medford, OR 97504 | 2005-07-28 |
| 1720424591 | Minji Kim | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504-6169 | 2013-05-20 |
| 1578821013 | Sabre Amira Patton-fee | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504 | 2012-05-02 |
| 1689955536 | Pawani Sachar | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504-6169 | 2011-09-06 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.