Provider Demographics
NPI:1760523831
Name:PROWS, RALPH MERRILL (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:MERRILL
Last Name:PROWS
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 1:2131 NE STANTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 SW MARKET ST
Practice Address - Street 2:MAIL STOP E12A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5715
Practice Address - Country:US
Practice Address - Phone:503-225-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18657207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORE16657Medicare UPIN
OR108256Medicare ID - Type Unspecified