Provider Demographics
NPI:1316142425
Name:BADER, FAYEZ A (MD)
Entity type:Individual
Prefix:MR
First Name:FAYEZ
Middle Name:A
Last Name:BADER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MISSON ST. SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-6217
Mailing Address - Country:US
Mailing Address - Phone:503-588-3945
Mailing Address - Fax:503-588-0256
Practice Address - Street 1:801 MISSION ST. SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-6217
Practice Address - Country:US
Practice Address - Phone:503-588-3945
Practice Address - Fax:503-588-0256
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27656207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR24ZZ02Medicaid
OR24ZZ02Medicaid