Provider Demographics
NPI:1801878707
Name:RAMBOUSEK, EDWARD LAWRENCE (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LAWRENCE
Last Name:RAMBOUSEK
Suffix:
Gender:M
Credentials:DO
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 640
Mailing Address - Street 2:
Mailing Address - City:ESTACADA
Mailing Address - State:OR
Mailing Address - Zip Code:97023-0640
Mailing Address - Country:US
Mailing Address - Phone:503-630-4234
Mailing Address - Fax:503-630-4234
Practice Address - Street 1:381 NE MAIN ST
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-8529
Practice Address - Country:US
Practice Address - Phone:503-630-4234
Practice Address - Fax:503-630-4234
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO17804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR051479Medicaid
OR051479Medicaid
ORF37930Medicare UPIN