Healthcare Provider Details

I. General information

NPI: 1174665384
Provider Name (Legal Business Name): JAFFER H BASHEY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 NW SAMARITAN DR SUITE 210
CORVALLIS OR
97330-3784
US

IV. Provider business mailing address

3640 NW SAMARITAN DR SUITE 210
CORVALLIS OR
97330-3784
US

V. Phone/Fax

Practice location:
  • Phone: 541-752-7721
  • Fax: 541-757-8072
Mailing address:
  • Phone: 541-752-7721
  • Fax: 541-757-8072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD18399
License Number StateOR

VIII. Authorized Official

Name: JAFFER H BASHEY
Title or Position: OWNER
Credential: MD
Phone: 541-752-7721