Provider Demographics
NPI:1124241674
Name:BEAUMONT, RALPH HARRISON (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:HARRISON
Last Name:BEAUMONT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 NW IRVING ST
Mailing Address - Street 2:SUITE 709
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2721
Mailing Address - Country:US
Mailing Address - Phone:503-279-8826
Mailing Address - Fax:503-241-8825
Practice Address - Street 1:1314 NW IRVING ST
Practice Address - Street 2:SUITE 709
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2721
Practice Address - Country:US
Practice Address - Phone:503-279-8826
Practice Address - Fax:503-241-8825
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR20290102L00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORA67113Medicare UPIN