MEDICARE: ANTHONY B RATANAPROEKSA 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	207P00000X	Emergency Medicine Physician	MD126237	OR

General Provider Information

NPI Number	:	1831398353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY B RATANAPROEKSA MD

Provider Business Mailing Address
First Line	:	1631 NE BROADWAY
Second Line	:	#413
City	:	PORTLAND
State	:	OR
Zip	:	97232-1425
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1631 NE BROADWAY
Second Line	:	#413
City	:	PORTLAND
State	:	OR
Zip	:	97232-1425
Country	:	US
Telephone Number	:	503-807-6532
Fax Number	:

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

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	02/09/2011

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