Provider Demographics
NPI:1619946563
Name:PASTRANO, JOE A (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:A
Last Name:PASTRANO
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:PO BOX 1747
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0136
Mailing Address - Country:US
Mailing Address - Phone:541-773-2493
Mailing Address - Fax:541-779-3027
Practice Address - Street 1:842 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7134
Practice Address - Country:US
Practice Address - Phone:541-773-2493
Practice Address - Fax:541-779-3027
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT112972085B0100X
ORMD1509622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500622808Medicaid
NC2050254Medicare ID - Type Unspecified
OR500622808Medicaid