Provider Demographics
NPI:1184660748
Name:BILAUCA, SORIN (PAC)
Entity Type:Individual
Prefix:
First Name:SORIN
Middle Name:
Last Name:BILAUCA
Suffix:
Gender:M
Credentials:PAC
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 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-7850
Mailing Address - Fax:541-732-7851
Practice Address - Street 1:940 ROYAL AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6193
Practice Address - Country:US
Practice Address - Phone:541-732-7850
Practice Address - Fax:541-732-7851
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2824363AS0400X
CAPA16759363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ794819Medicaid
AZAZ0145440OtherBCBS AZ
AZ794819OtherAHCCCS
AZAZ0145440OtherBCBS AZ
AZ794819Medicaid