Individual
DR. SALLY JANE MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3600 NW SAMARITAN DR, CORVALLIS, OR 97330-3737
(541) 768-4906
Mailing address
3600 NW SAMARITAN DR, CORVALLIS, OR 97330-3737
(541) 768-4906
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
177159
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1698153
—
AK
Enumeration date
04/16/2016
Last updated
09/24/2019
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