Provider Demographics
NPI:1386647923
Name:PATIL, RAVINDRA R (MD, PHD)
Entity Type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:R
Last Name:PATIL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16130 SW BRAY LN
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-1090
Mailing Address - Country:US
Mailing Address - Phone:503-521-8267
Mailing Address - Fax:503-521-8267
Practice Address - Street 1:727 S WAHANNA RD
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-7735
Practice Address - Country:US
Practice Address - Phone:503-717-7650
Practice Address - Fax:503-717-7624
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21026207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288039Medicaid
OR134620Medicare ID - Type Unspecified
G74316Medicare UPIN