Provider Demographics
NPI:1689760472
Name:BASILAN, RICHARD DE QUIROZ (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DE QUIROZ
Last Name:BASILAN
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 1:2720 COMMERCIAL ST SE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4495
Mailing Address - Country:US
Mailing Address - Phone:503-540-9999
Mailing Address - Fax:
Practice Address - Street 1:2720 COMMERCIAL ST SE
Practice Address - Street 2:SUITE #201
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4495
Practice Address - Country:US
Practice Address - Phone:503-540-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005012151207R00000X
ORMD154343207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine