1548017577 NPI number — KALEB ANTHONY RANKIN MD

Table of content: KALEB ANTHONY RANKIN MD (NPI 1548017577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548017577 NPI number — KALEB ANTHONY RANKIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANKIN
Provider First Name:
KALEB
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548017577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100, 49 VICHITSONGKRAM RD
Provider Second Line Business Mailing Address:
GROUND FLOOR
Provider Business Mailing Address City Name:
KATHU
Provider Business Mailing Address State Name:
PHUKET
Provider Business Mailing Address Postal Code:
83120
Provider Business Mailing Address Country Code:
TH
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20048 TORREY PINES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREGON CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97045-7027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-877-2511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/06/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  20-P-19 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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