Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Cullen Anthony Mack, PA

Individual provider Physician Assistant · NPI 1104369099

Mr. Cullen Anthony Mack, PA is a Physician Assistant in Medford, Oregon. Qualified in 2016, 10 years ago. Practices with Providence Health and Services Oregon, a 164-clinician group and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
10
Licensed in
OR
In the registry since
2016
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

235 E Barnett Rd Ste 106
Medford, OR 97501-7901
Phone: (541) 773-4029
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 180563 (OR)

Record details

NPI number1104369099
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedNovember 23, 2016
Last updated in NPPESMarch 7, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Providence Health And Services Oregon — 164 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Medford