Individual
DR. RAJESH RAVURI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4505
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4505
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD23904
OR
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
MD23904
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110233976
RR MEDICARE PTAN NUMBER
OR
01
—
1407812365
NBMC GROUP NPI NUMBER
OR
05
—
286464
—
OR
01
—
CD8723
RR MEDICARE GROUP NUMBER
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
12/09/2005
Last updated
11/06/2020
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