Provider Demographics
NPI:1174535868
Name:RASMUSSEN, RICHARD DEAN (MDPHD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DEAN
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:MDPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 NE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1293
Mailing Address - Country:US
Mailing Address - Phone:541-479-3367
Mailing Address - Fax:541-479-0215
Practice Address - Street 1:1309 NE 6TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1293
Practice Address - Country:US
Practice Address - Phone:541-479-3367
Practice Address - Fax:541-479-0215
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18237174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR057351Medicaid
R00WCNGNCMedicare PIN