Provider Demographics
NPI:1144323346
Name:BASILAN, DENISE STELLA BARBA (MD)
Entity type:Individual
Prefix:
First Name:DENISE STELLA
Middle Name:BARBA
Last Name:BASILAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:S
Other - Last Name:BARBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4744 LIBERTY RD S
Mailing Address - Street 2:# 120
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:971-599-1002
Mailing Address - Fax:503-967-6107
Practice Address - Street 1:4744 LIBERTY RD S
Practice Address - Street 2:#120
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:971-599-1002
Practice Address - Fax:501-967-6107
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD189073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine