| Doctor Name: | REDA T BASSALY |
| NPI Number: | 1043551930 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | |
| Business Practice Address: | 2850 Se Powell Valley Rd Gresham, OR - 970801494 |
| Business Phone Number: | 5036665050 |
| Business Fax Number: | 5036661162 |
| Mailing Address: | Po Box 3777, PORTLAND |
| State: | OR |
| Postal Code: | 972083777 |
| Phone Number: | 5034133900 |
| Fax Number: | 5034133710 |
| NPI Enumeration Date: | 03/03/2013 |
| NPI Last Update Date: | 05/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |