Coos Radiosurgery Group LLC

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

Legal business name

COOS RADIOSURGERY GROUP LLC

Practice address

1775 Thompson Rd
Coos Bay, OR 97420-2125

Phone

(541) 269-8520

NPI assigned

Mar 9, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brian G Fuller, MD

Title

Manager

Phone

(301) 529-7222

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521676800000",
    "number": "1710480397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 398974",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941398974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 THOMPSON RD",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202125",
            "telephone_number": "541-269-8520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOS RADIOSURGERY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-09",
        "last_updated": "2018-03-22",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "301-529-7222",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coos Bay Vision Center, LLC
• Coos Clinic LLC
• Coos County Oregon
• Coos County Oregon
• Coos County Oregon
• Coquille Indian Tribe
• Coquille Indian Tribe
• Coquille Indian Tribe
• Coquille Valley Health
• Coquille Valley Health

• All providers in Coos Bay, OR
• Radiation Oncology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.