Provider Demographics
NPI:1922151778
Name:MENAGH, PHILIP JERRELL
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JERRELL
Last Name:MENAGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4619
Mailing Address - Country:US
Mailing Address - Phone:503-544-1613
Mailing Address - Fax:
Practice Address - Street 1:1330 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4619
Practice Address - Country:US
Practice Address - Phone:503-544-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program