MEDICARE: RAVINDRA R PATIL M.D., PHD

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	207RX0202X	Medical Oncology Physician	MD21026	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386647923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVINDRA R PATIL M.D., PHD

Provider Business Mailing Address
First Line	:	16130 SW BRAY LN
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97224-1090
Country	:	US
Telephone Number	:	503-521-8267
Fax Number	:	503-521-8267

Provider Business Practice Location Address
First Line	:	727 S WAHANNA RD
Second Line	:
City	:	SEASIDE
State	:	OR
Zip	:	97138-7735
Country	:	US
Telephone Number	:	503-717-7650
Fax Number	:	503-717-7624

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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