Provider Demographics
NPI:1801956685
Name:PALING, MICHAEL ROYCE (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROYCE
Last Name:PALING
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 1:6464 SW BORLAND ROAD SUITE A4
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8854
Mailing Address - Country:US
Mailing Address - Phone:503-692-5737
Mailing Address - Fax:503-692-5307
Practice Address - Street 1:LEGACY MERIDIAN PARK HOSPITAL
Practice Address - Street 2:19300 SW 65TH
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8854
Practice Address - Country:US
Practice Address - Phone:503-692-5737
Practice Address - Fax:503-692-5307
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD187142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287806Medicaid
OR108924Medicare ID - Type Unspecified
OR287806Medicaid