Individual
PATAN GULTAWATVICHAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9495 SW LOCUST ST STE G, PORTLAND, OR 97223-6683
(971) 314-4522
(971) 314-4527
Mailing address
5 NEPONSET ST, WORCESTER, MA 01606-2714
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
274829
MA
207RH0003X
Hematology & Oncology Physician
Primary
MD221300
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110115607A
—
MA
Enumeration date
08/07/2012
Last updated
11/27/2024
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