1023042025 NPI number — BHANU PRASAD PALADUGU MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023042025 NPI number — BHANU PRASAD PALADUGU MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PALADUGU

Provider First Name:

BHANU PRASAD

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1023042025

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/21/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 708850

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SANDY

Provider Business Mailing Address State Name:

UT

Provider Business Mailing Address Postal Code:

84070-8850

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

866-869-2395

Provider Business Mailing Address Fax Number:

801-352-7976

Provider First Line Business Practice Location Address:

2700 NW STEWART PKWY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ROSEBURG

Provider Business Practice Location Address State Name:

OR

Provider Business Practice Location Address Postal Code:

97470-1281

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

561-677-1773

Provider Business Practice Location Address Fax Number:

541-677-1794

Provider Enumeration Date:

07/10/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  MD26626 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 005973 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
• Identifier: 844477037 . This is a "BCBS-GRANTS PASS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
• Identifier: 858464036 . This is a "BCBS-ROSEBURG" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
• Identifier: 77172 . This is a "BCBS-CALDWELL" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
• Identifier: B6227 . This is a "BCBS-NAMPA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
• Identifier: P00366050 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
• Identifier: 807958100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
• Identifier: 838366029 . This is a "BCBS-MCMINNVILLE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
• Identifier: 858463035 . This is a "BCBS-MEDFORD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
• Identifier: 858464036 . This is a "BCBS-SPRINGFIELD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".