Individual
DR. CHANDRA MARIE BASHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10535 NE GLISAN ST, PORTLAND, OR 97220-4077
(503) 273-5142
Mailing address
PO BOX 22061, MILWAUKIE, OR 97269-2061
(503) 659-1978
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD 27394
OR
390200000X
Student in an Organized Health Care Education/Training Program
A97048
CA
390200000X
Student in an Organized Health Care Education/Training Program
MD27394
OR
Other
Enumeration date
05/08/2007
Last updated
08/08/2013
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