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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
MD12356 | OR | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
OR | RAILROAD MEDICARE | 060070869 | 01 |
OR | 114173 | 05 | |
OR | LICENSE | MD12356 | 01 |
Street Address |
2801 NW MERCY DR STE. 300 |
City | ROSEBURG |
State | OR |
Zip Code | 97471 |
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 |
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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 Code | 207RC0000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Cardiovascular Disease |
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. |
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 |
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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.