Healthcare Provider Details

I. General information

NPI: 1114452521
Provider Name (Legal Business Name): PAULA BABB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2017
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 NE CUSHING DR
BEND OR
97701-3876
US

IV. Provider business mailing address

1348 NE CUSHING DR
BEND OR
97701-3876
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-7696
  • Fax: 541-389-5723
Mailing address:
  • Phone: 541-382-7696
  • Fax: 541-389-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number76571
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: