Organization
CORVALLIS MEDICAL GROUP LLC
Active
Other names
CORVALLIS PAIN MANAGEMENT
Organization subpart
No
Provider details
NPI number
Authorized official
JULIA BULL RASK PE (CHIEF FINANCIAL OFFICER)
(541) 368-3032
Entity
Organization
Contact information
Practice address
800 NE CIRCLE BLVD, CORVALLIS, OR 97330-4256
(541) 286-4742
(833) 450-5933
Mailing address
800 NE CIRCLE BLVD, CORVALLIS, OR 97330-4256
(541) 286-4742
(833) 450-5933
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130103
—
OR
Enumeration date
05/11/2015
Last updated
04/22/2024
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