Basic Information
| Provider Information | |||||||||
| NPI: | 1023042025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALADUGU | ||||||||
| FirstName: | BHANU PRASAD | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 708850 | ||||||||
| Address2: | |||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840708850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668692395 | ||||||||
| FaxNumber: | 8013527976 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 NW STEWART PKWY | ||||||||
| Address2: | |||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974701281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616771773 | ||||||||
| FaxNumber: | 5416771794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 05/21/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD26626 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 005973 | 05 | OR | MEDICAID | 844477037 | 01 | OR | BCBS-GRANTS PASS | OTHER | 858464036 | 01 | OR | BCBS-ROSEBURG | OTHER | 77172 | 01 | ID | BCBS-CALDWELL | OTHER | B6227 | 01 | ID | BCBS-NAMPA | OTHER | P00366050 | 01 | OR | RAIL ROAD MEDICARE | OTHER | 807958100 | 05 | ID | MEDICAID | 838366029 | 01 | OR | BCBS-MCMINNVILLE | OTHER | 858463035 | 01 | OR | BCBS-MEDFORD | OTHER | 858464036 | 01 | OR | BCBS-SPRINGFIELD | OTHER |