Provider Demographics
NPI:1639264856
Name:SOGN, RICHARD RANDOLPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RANDOLPH
Last Name:SOGN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9900 SW WILSHIRE STREET
Mailing Address - Street 2:SUITE 260
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5025
Mailing Address - Country:US
Mailing Address - Phone:503-292-4411
Mailing Address - Fax:503-292-4298
Practice Address - Street 1:9900 SW WILSHIRE STREET
Practice Address - Street 2:SUITE 260
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5025
Practice Address - Country:US
Practice Address - Phone:503-292-4411
Practice Address - Fax:503-292-4298
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR162162084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR042952Medicaid
ORE41466Medicare UPIN
OR0000BKBBKMedicare ID - Type Unspecified