FREDERIC J VAN DIS


Address: 2801 Nw Mercy Dr, Ste. 300, Roseburg, OR 97471
Phone: 5416771555

FREDERIC J VAN DIS (NPI# 1093786261) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1093786261
Entity Type Individual
Full Name FREDERIC J VAN DIS
Credential MD
Practice Address 2801 Nw Mercy Dr
Ste. 300
Roseburg
OR 97471
Mailing Address 201 Nw Medical Loop Ste 190
Roseburg
OR 97471-8835
Practice Telephone 5416771555
Practice Fax Number 5416776543
Mailing Telephone 5416774319
Mailing Fax Number 5416772294
Enumeration Date 2006-01-27
Last Update Date 2020-05-26
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RC0000X Internal Medicine
Specialization: Cardiovascular Disease
MD12356 OR Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
OR RAILROAD MEDICARE 060070869 01
OR 114173 05
OR LICENSE MD12356 01

Office Location

Street Address 2801 NW MERCY DR
STE. 300
City ROSEBURG
State OR
Zip Code 97471

Providers in the same location

NPI Name Taxonomy Address Enumeration
1174528038 Ambulatory Surgery Center of Roseburg, LLC Clinic/Center 2801 Nw Mercy Dr, Ste 200, Roseburg, OR 97470-2348 2005-06-16
1518341437 Jeremy James Wedge Registered Nurse 2801 Nw Mercy Dr, Suite 200, Roseburg, OR 97471-2348 2015-07-10
1699173161 Hilary Oakes Nurse Practitioner 2801 Nw Mercy Dr, Ste. 300, Roseburg, OR 97471-2348 2014-12-15
1891003497 Centennial Medical Group West, LLC Internal Medicine 2801 Nw Mercy Dr, Suite 345, Roseburg, OR 97471-2348 2010-09-16
1528375532 Christine Yap Villardo Hospitalist 2801 Nw Mercy Dr, Suite 340, Roseburg, OR 97471-2348 2010-09-13
1902132483 Ent Associates of Roseburg LLC Otolaryngology 2801 Nw Mercy Dr, Suite 330, Roseburg, OR 97471-2348 2009-10-19
1356517098 Bryan Michael Mcvay Surgery 2801 Nw Mercy Dr, Suite 330, Roseburg, OR 97471-6214 2008-05-02
1205057908 Sharyse L Williams Registered Nurse 2801 Nw Mercy Dr, Suite 330, Roseburg, OR 97470-2348 2007-05-01
1356425169 Umpqua Orthopedics Specialist 2801 Nw Mercy Dr, Ste 300, Roseburg, OR 97470-2348 2006-10-25
1932284528 Gary Bronstein Internal Medicine 2801 Nw Mercy Dr, Suite 300, Roseburg, OR 97471-2348 2006-10-25
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1841805660 Rae Ann Barnes Pharmacist 913 Ne Garden Valley Blvd, Pharmacy, Roseburg, OR 97471 2020-09-09
1023651031 Colton Phillips Behavioral Analyst 940 Nw Garden Valley Bvld #104, Roseburg, OR 97471 2019-10-22
1952884876 Meredith Krugel Lcsw PC Clinic/Center 2225 Nw Stewart Parkway Ste 200, Roseburg, OR 97471 2018-09-07
1114456563 Philip Kaser Family, LLC Pharmacy 1175 W. Harvard Avenue, Roseburg, OR 97471 2017-06-08
1053854208 Icco LLC Clinic/Center 1740 Nw Goetz Street, Roseburg, OR 97471 2016-11-21
1770034589 Evie Jepsen Case Manager/Care Coordinator 2700 Stewart Parkway Annex B, Suite 110, Roseburg, OR 97471 2016-10-17
1932551256 Jonathan Schmidt Licensed Practical Nurse 913 Nm Garden Valley Blvd, Va Roseburg Medical Center, Roseburg, OR 97471 2016-07-11
1932580586 Jeffrey Mark Wareham Case Manager/Care Coordinator 2700 Medical Loop, Annex B, Roseburg, OR 97471 2015-06-09
1558784215 Ginger Jean Thibedeau Massage Therapist 3019 Nw Stewart Parkway, Suite 304 #183, Roseburg, OR 97471 2014-01-30
1427303122 Karishma Parekh Internal Medicine 2460 Nw Stewart Pkwy Ste 103, Roseburg, OR 97471 2012-07-18
Find all providers in zip 97471

Taxonomy Information

Taxonomy Code 207RC0000X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Cardiovascular Disease

Taxonomy Definition

An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1518103274 Centennial Medical Group Inc. Internal Medicine 201 Nw Medical Loop Ste 190, Roseburg, OR 97471-8835 2008-12-31
1497820583 Frances C Munkenbeck Md PC Internal Medicine 2700 Nw Stewart Parkway 200, Roseburg, OR 97470 2006-11-22
1639275712 Lifetime Health Clinic Internal Medicine 868 Northwest Garden Valley Boulevard, Roseburg, OR 97470-1959 2006-09-15
1841294774 Douglas Edward Anderson Internal Medicine 2801 Nw Mercy Dr Ste 300, Roseburg, OR 97471-2348 2005-06-09
1417225939 Ibrahim Osman Internal Medicine 2801 Nw Mercy Dr Ste 300, Roseburg, OR 97471 2011-12-12
1730308529 Roseburg Heart Associates PC Internal Medicine 2700 Nw Stewart Pkwy, Suite 200, Roseburg, OR 97470-1281 2007-04-24
1285753160 Courtney Rae Virgilio Internal Medicine 2801 Nw Mercy Dr Ste 300, Roseburg, OR 97471-2348 2007-03-29
1932284528 Gary Bronstein Internal Medicine 2801 Nw Mercy Dr, Suite 300, Roseburg, OR 97471-2348 2006-10-25
1083703078 Cynthia Brownson Kremser Internal Medicine 489 Cherokee Ave, Roseburg, OR 97470-9534 2006-10-11
1992728760 Leslie Vernor Walker Internal Medicine 913 Nw Garden Valley Blvd, Roseburg, OR 97470-6523 2006-07-25
Find all providers in ROSEBURG

Competitor

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City ROSEBURG
Zip Code 97471

Improve Information

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Dataset Information

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.

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