Individual
LOUIS P. RICCELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 418-0990
Mailing address
3181 SW SAM JACKSON PARK RD, CR-135, PORTLAND, OR 97239-3011
(503) 494-7576
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD22468
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023075
—
OR
Enumeration date
07/31/2006
Last updated
06/24/2020
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