Provider Demographics
NPI:1568658193
Name:RIZVI, GULRUKH (MD)
Entity Type:Individual
Prefix:
First Name:GULRUKH
Middle Name:
Last Name:RIZVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3417
Mailing Address - Country:US
Mailing Address - Phone:541-972-3627
Mailing Address - Fax:877-992-4905
Practice Address - Street 1:1161 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3417
Practice Address - Country:US
Practice Address - Phone:541-972-3627
Practice Address - Fax:877-992-4905
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD150097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine