Provider Demographics
NPI:1932176187
Name:PANUM, PAMELA A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:A
Last Name:PANUM
Suffix:
Gender:F
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 24410
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 HILYARD ST STE 510
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8150
Practice Address - Country:US
Practice Address - Phone:458-205-6074
Practice Address - Fax:541-687-6154
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13418207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR284661Medicaid
ORRR PTAN 160026663Medicare PIN
ORR016WFBFRDMedicare PIN
D72845Medicare UPIN