Provider Demographics
NPI:1144280033
Name:LJUNGKVIST, VALERIE ANN (MD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:LJUNGKVIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:ANN
Other - Last Name:LORVIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:126 PIONEER
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520
Mailing Address - Country:US
Mailing Address - Phone:541-608-4096
Mailing Address - Fax:541-608-4073
Practice Address - Street 1:750 MURPHY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-608-4096
Practice Address - Fax:541-608-4073
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26030208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I40208Medicare UPIN
132458Medicare ID - Type Unspecified