Healthcare Provider Details

I. General information

NPI: 1568623072
Provider Name (Legal Business Name): RAGHU U VARIER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N GRAHAM ST SUITE 420
PORTLAND OR
97227-1683
US

IV. Provider business mailing address

300 N GRAHAM ST SUITE 420
PORTLAND OR
97227-1683
US

V. Phone/Fax

Practice location:
  • Phone: 503-281-5139
  • Fax: 503-249-3782
Mailing address:
  • Phone: 503-281-5139
  • Fax: 503-249-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberDO166555
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: