MEDICARE: RAMESIS BACOLOD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	RL12297	ND
2	207Q00000X	Family Medicine Physician	MD171022	OR

General Provider Information

NPI Number	:	1205196417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMESIS BACOLOD MD

Provider Business Mailing Address
First Line	:	2620 E BARNETT RD
Second Line	:	SUITE H
City	:	MEDFORD
State	:	OR
Zip	:	97504-8383
Country	:	US
Telephone Number	:	541-789-4281
Fax Number	:	541-789-2558

Provider Business Practice Location Address
First Line	:	700 SW RAMSEY AVE
Second Line	:	SUITE 101
City	:	GRANTS PASS
State	:	OR
Zip	:	97527-5786
Country	:	US
Telephone Number	:	541-507-2080
Fax Number	:	541-507-2081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	12/20/2021

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Directions to “ RAMESIS BACOLOD MD” Practice Location

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