Provider Demographics
NPI:1104867852
Name:OLER, RALPH CLYDE (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:CLYDE
Last Name:OLER
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 1:709 AQUARIUS WAY
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-3207
Mailing Address - Country:US
Mailing Address - Phone:541-962-8420
Mailing Address - Fax:
Practice Address - Street 1:709 AQUARIUS WAY
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-3207
Practice Address - Country:US
Practice Address - Phone:541-962-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 08714207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR234146Medicaid
OR114063Medicare ID - Type Unspecified
OR234146Medicaid