Basic Information
| Provider Information | |||||||||
| NPI: | 1477936466 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | RAI | ||||||||
| FirstName: | MANOJ | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2640 E BARNETT RD # E333 | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975044301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412826770 | ||||||||
| FaxNumber: | 5412826771 | ||||||||
| Practice Location | |||||||||
| Address1: | 3181 SW SAM JACKSON PARK RD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972393011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412826770 | ||||||||
| FaxNumber: | 5412826771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2015 | ||||||||
| LastUpdateDate: | 09/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301107650 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD192294 | OR | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.