Individual provider · NPI-1

Dr. Derwood E Basham, D.O.

Family Medicine · Roseburg, OR

NPI number1053535120
StatusActive
Last updated in NPPESJul 17, 2015

Details

NPI
1053535120
Entity type
Individual (NPI-1)
Name
Dr. Derwood E Basham
Credential
D.O.
Sex
Male
Sole proprietor
No
Enumeration date
Apr 12, 2007
Last updated
Jul 17, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineDO171270ORYes

Practice location

2371 Ne Stephens St
Suite 200
Roseburg, OR 97470-1372

Phone 541-672-8533 · Fax 541-672-4993

Mailing address

2371 Ne Stephens St
Suite 200
Roseburg, OR 97470-1372

Phone 541-672-8533 · Fax 541-672-4993

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