Individual
MR. SHASHANK BATHULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3680 NW SAMARITAN DR, CORVALLIS, OR 97330-3737
(541) 754-1150
Mailing address
444 NW ELKS DR, CORVALLIS, OR 97330-3745
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5151014660
MI
207R00000X
Internal Medicine Physician
Primary
DO218912
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/15/2018
Last updated
07/18/2024
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