Provider Demographics
NPI:1184722795
Name:LEWALLEN, PATRICK K (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:K
Last Name:LEWALLEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:501 N GRAHAM STREET
Mailing Address - Street 2:SUITE 265
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227
Mailing Address - Country:US
Mailing Address - Phone:503-282-7002
Mailing Address - Fax:503-280-1290
Practice Address - Street 1:2500 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6015
Practice Address - Country:US
Practice Address - Phone:541-382-4321
Practice Address - Fax:541-706-7068
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD143182080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR125658Medicaid