Provider Demographics
NPI:1972750669
Name:J RAFE SALES, MD PC
Entity Type:Organization
Organization Name:J RAFE SALES, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-546-3503
Mailing Address - Street 1:9155 SW BARNES RD STE 210
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6629
Mailing Address - Country:US
Mailing Address - Phone:503-546-3503
Mailing Address - Fax:503-546-3507
Practice Address - Street 1:9155 SW BARNES RD STE 210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6629
Practice Address - Country:US
Practice Address - Phone:503-546-3503
Practice Address - Fax:503-546-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26298174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty