Provider Demographics
NPI:1275572133
Name:KOESEL, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:KOESEL
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 1:545 NE 47TH AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2238
Mailing Address - Country:US
Mailing Address - Phone:503-731-2900
Mailing Address - Fax:
Practice Address - Street 1:545 NE 47TH AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2238
Practice Address - Country:US
Practice Address - Phone:503-731-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD266092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR840126022OtherREGENCE BS/BC
ORP00341155OtherRR MC
OR240496Medicaid
WA8460792Medicaid
OR840126022OtherREGENCE BS/BC
ORR134804Medicare PIN