Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 13131 | OR |
NPI | 1194831354 |
---|---|
Provider Name | Dr. Paul Michael Raether |
First Address | Portland, OR 97239-2100 |
Second Address | Clackamas, OR 97015-9750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |