Provider Demographics
NPI:1396790192
Name:WOODRUFF, RONALD RUDOLPH (PA-C)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:RUDOLPH
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 ORCHARD HILL LN
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1191
Mailing Address - Country:US
Mailing Address - Phone:503-245-6193
Mailing Address - Fax:
Practice Address - Street 1:610 NE FOURTH PLAIN BLVD V3C&P
Practice Address - Street 2:VETERANS AFFAIRS MEDICAL CENTER
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00757363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant