Individual
DR. SOMNATH JAGANNATH PRABHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
938 NW KINGS BLVD, CORVALLIS, OR 97330-2505
(541) 758-5047
(541) 758-3713
Mailing address
PO BOX 1418, CORVALLIS, OR 97339-1418
(805) 286-3826
(805) 221-6843
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD199646
OR
2085R0202X
Diagnostic Radiology Physician
MD60479844
WA
2085R0202X
Diagnostic Radiology Physician
ML60026972
WA
208600000X
Surgery Physician
ML60026972
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2018572
—
WA
Enumeration date
10/02/2008
Last updated
01/18/2021
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