Individual
REDA TAWFIK BASSALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
325 PARK ST, LEBANON, OR 97355-4229
(541) 451-7200
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA163414
OR
363AM0700X
Medical Physician Assistant
Primary
PA163414
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2035614
—
WA
05
—
500657182
—
OR
Enumeration date
03/03/2013
Last updated
10/06/2025
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