Healthcare Provider Details

I. General information

NPI: 1427923192
Provider Name (Legal Business Name): OREGON COAST WOUND CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 THOMPSON RD
COOS BAY OR
97420-2150
US

IV. Provider business mailing address

780 2ND ST SE STE 7
BANDON OR
97411-8354
US

V. Phone/Fax

Practice location:
  • Phone: 541-329-2555
  • Fax: 971-233-3243
Mailing address:
  • Phone: 541-329-2555
  • Fax: 971-233-3243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: BABAK BAHARLOO
Title or Position: OWNER
Credential: DMP
Phone: 541-329-2555