Provider Demographics
NPI:1578563086
Name:RENDLEMAN, NEAL JAMES (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:JAMES
Last Name:RENDLEMAN
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 1:3021 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-228-8745
Mailing Address - Fax:
Practice Address - Street 1:10305 SW PARK WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-295-0730
Practice Address - Fax:503-295-0731
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13206207R00000X
OROR13206207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR285841Medicaid
OR285841Medicaid
OR116368Medicare ID - Type Unspecified
OR139903Medicare PIN
ORAB35201Medicare ID - Type Unspecified