Individual
SHELLY R SVOBODA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
444 NW ELKS DR, CORVALLIS, OR 97330-3745
(541) 754-1150
Mailing address
444 NW ELKS DR, CORVALLIS, OR 97330-3745
(541) 754-1150
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
41101
MN
2084N0400X
Neurology Physician
Primary
MD152419
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145421800
—
MN
05
—
500625065
—
OR
01
—
P00958597
RAILROAD MEDICARE
OR
Enumeration date
06/16/2005
Last updated
10/26/2011
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