Provider Demographics
NPI:1174665384
Name:JAFFER H BASHEY MD PC
Entity Type:Organization
Organization Name:JAFFER H BASHEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAFFER
Authorized Official - Middle Name:H
Authorized Official - Last Name:BASHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-752-7721
Mailing Address - Street 1:3640 NW SAMARITAN DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3784
Mailing Address - Country:US
Mailing Address - Phone:541-752-7721
Mailing Address - Fax:541-757-8072
Practice Address - Street 1:3640 NW SAMARITAN DR
Practice Address - Street 2:SUITE 210
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3784
Practice Address - Country:US
Practice Address - Phone:541-752-7721
Practice Address - Fax:541-757-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18399174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG73010Medicare UPIN
OR121379Medicare ID - Type Unspecified