# PAUL B BASCOM MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720407463
- **Authorized official:** PAUL B BASCOM M.D. (OWNER)
- **Authorized official phone:** (503) 961-2017

## Contact information

- **Practice address:** 94220 4TH ST, GOLD BEACH, OR 97444-7756
- **Practice address phone:** (503) 961-2017
- **Mailing address:** 3439 NE SANDY BLVD, MAILBOX 601, PORTLAND, OR 97232-1959
- **Mailing address phone:** (503) 961-2017

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | MD16983 | OR | Yes |

## Other

- **Enumeration date:** 04/09/2014
- **Last updated:** 04/09/2014