Healthcare Provider Details

I. General information

NPI: 1700415932
Provider Name (Legal Business Name): PEDRO ABDALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 N 10TH AVE
STAYTON OR
97383-2037
US

IV. Provider business mailing address

1371 N 10TH AVE
STAYTON OR
97383-2037
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-3785
  • Fax:
Mailing address:
  • Phone: 503-769-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD225631
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: