Provider Demographics
NPI:1194894865
Name:SENOGLES, GERALD JAMES (LAC)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:JAMES
Last Name:SENOGLES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 E. JACKSON ST.
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6713
Mailing Address - Country:US
Mailing Address - Phone:541-779-6223
Mailing Address - Fax:541-779-5496
Practice Address - Street 1:809 E. JACKSON ST.
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6713
Practice Address - Country:US
Practice Address - Phone:541-779-6223
Practice Address - Fax:541-779-5496
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00038171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist