Healthcare Provider Details

I. General information

NPI: 1669586467
Provider Name (Legal Business Name): GABRIEL RAMA MAYLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 DAGGETT AVE STE 100
KLAMATH FALLS OR
97601-1106
US

IV. Provider business mailing address

2074 SOUTH SIXTH ST
KLAMATH FALLS OR
97601
US

V. Phone/Fax

Practice location:
  • Phone: 541-274-6733
  • Fax: 541-274-2006
Mailing address:
  • Phone: 925-930-6346
  • Fax: 541-851-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA90871
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD26937
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: