Provider Demographics
NPI:1104885409
Name:PRAUNER, RONALD DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DAVID
Last Name:PRAUNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2801 N. GANTENBEIN AVE, 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227
Mailing Address - Country:US
Mailing Address - Phone:503-276-9300
Mailing Address - Fax:503-276-9351
Practice Address - Street 1:2801 N. GANTENBEIN AVE, 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227
Practice Address - Country:US
Practice Address - Phone:503-276-9300
Practice Address - Fax:503-276-9351
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE183792080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN