Healthcare Provider Details

I. General information

NPI: 1699685438
Provider Name (Legal Business Name): DONOVAN BAHALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELSON S. FLOYD COLLEGE OF MEDICINE 805 BROADWAY STREET SUITE 315
VANCOUVER WA
98660
US

IV. Provider business mailing address

ELSON S. FLOYD COLLEGE OF MEDICINE 805 BROADWAY STREET SUITE 315
VANCOUVER WA
98660
US

V. Phone/Fax

Practice location:
  • Phone: 360-583-3675
  • Fax:
Mailing address:
  • Phone: 360-583-3675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: