Provider Demographics
NPI:1023197647
Name:BURKE, RALPH LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:LEONARD
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16760
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0760
Mailing Address - Country:US
Mailing Address - Phone:503-781-3063
Mailing Address - Fax:
Practice Address - Street 1:6315 SE MORRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1943
Practice Address - Country:US
Practice Address - Phone:503-781-3063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR004903Medicaid
OR004903Medicaid
ORR107626Medicare ID - Type Unspecified