Petersen, Ronald Raymond

Petersen, Ronald Raymond is an individual health care provider with primary practice located at 1111 Ne 99Th Ave Suite 201, Portland OR 97220-9428. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Petersen, Ronald Raymond can be contacted via phone (503) 962-1000.

Contact Information

Primary practice address
1111 Ne 99Th Ave Suite 201 Portland OR 97220-9428
Phone: (503) 962-1000
Fax: (503) 963-3005
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X MD13668 Oregon

Profile Details

NPI number 1225020514
LBN Legal business name Petersen, Ronald Raymond
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 22nd, 2005
Last updated Nov 12th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225020514 NPPES
Oregon MEDICAID 025148

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