Provider Demographics
NPI:1518296847
Name:BAHNSON, FREDERIC NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:NATHAN
Last Name:BAHNSON
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 1188
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1188
Mailing Address - Country:US
Mailing Address - Phone:541-812-4580
Mailing Address - Fax:541-928-3169
Practice Address - Street 1:705 ELM ST SW
Practice Address - Street 2:SUITE 300
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1956
Practice Address - Country:US
Practice Address - Phone:541-812-4580
Practice Address - Fax:541-928-3169
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107095208600000X
ORMD156908208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery