Provider Demographics
NPI:1023042025
Name:PALADUGU, BHANU PRASAD (MD)
Entity Type:Individual
Prefix:
First Name:BHANU PRASAD
Middle Name:
Last Name:PALADUGU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 708850
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-8850
Mailing Address - Country:US
Mailing Address - Phone:866-869-2395
Mailing Address - Fax:801-352-7976
Practice Address - Street 1:2700 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1281
Practice Address - Country:US
Practice Address - Phone:561-677-1773
Practice Address - Fax:541-677-1794
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005973Medicaid
OR844477037OtherBCBS-GRANTS PASS
OR858464036OtherBCBS-ROSEBURG
ID77172OtherBCBS-CALDWELL
IDB6227OtherBCBS-NAMPA
ORP00366050OtherRAIL ROAD MEDICARE
ID807958100Medicaid
OR838366029OtherBCBS-MCMINNVILLE
OR858463035OtherBCBS-MEDFORD
OR858464036OtherBCBS-SPRINGFIELD
OR005973Medicaid
OR135937Medicare PIN
ORP00366050OtherRAIL ROAD MEDICARE
OR135938Medicare PIN