Healthcare Provider Details

I. General information

NPI: 1992284582
Provider Name (Legal Business Name): BAY AREA RADIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 SPENCERS CREST DR
EUGENE OR
97405-3595
US

IV. Provider business mailing address

PO BOX 2488 UNIT 20
PORTLAND OR
97208-2488
US

V. Phone/Fax

Practice location:
  • Phone: 559-455-4009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL E STOLL
Title or Position: SECRETARY
Credential: MD
Phone: 559-455-4009