Healthcare Provider Details

I. General information

NPI: 1639264856
Provider Name (Legal Business Name): RICHARD RANDOLPH SOGN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 SW WILSHIRE STREET SUITE 260
PORTLAND OR
97225-5025
US

IV. Provider business mailing address

9900 SW WILSHIRE STREET SUITE 260
PORTLAND OR
97225-5025
US

V. Phone/Fax

Practice location:
  • Phone: 503-292-4411
  • Fax: 503-292-4298
Mailing address:
  • Phone: 503-292-4411
  • Fax: 503-292-4298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number16216
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier042952
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: