Individual
RUTH ELLEN MEDAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2801 N GANTENBEIN AVE, PORTLAND, OR 97227-1623
(503) 413-6862
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
(503) 413-3710
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD09230
OR
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
MD09230
OR
Other
Enumeration date
02/24/2009
Last updated
05/12/2021
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