Individual
RAELIN FULLMER I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19300 SW 65TH AVE, TUALATIN, OR 97062
(503) 413-8407
Mailing address
19300 SW 65TH AVE, TUALATIN, OR 97062-7706
(503) 413-8407
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
177948
OR
207R00000X
Internal Medicine Physician
Primary
DO193586
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500749146
—
OR
Enumeration date
04/14/2014
Last updated
08/21/2019
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