Provider Demographics
NPI:1144205295
Name:WALI, DEEPIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPIKA
Middle Name:
Last Name:WALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEEPIKA
Other - Middle Name:
Other - Last Name:PARIMOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2120
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2120
Mailing Address - Country:US
Mailing Address - Phone:541-274-6556
Mailing Address - Fax:
Practice Address - Street 1:2610 UHRMANN RD
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1123
Practice Address - Country:US
Practice Address - Phone:541-274-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49021207RX0202X
ORCP203502207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABU558WOtherMCARE PTAN
CA00A490210OtherBCBS
CA00A490210OtherBCBS