Provider Demographics
NPI:1699869255
Name:JUAREZ, RALPH A (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:A
Last Name:JUAREZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 SE MAIN ST STE 11
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2937
Mailing Address - Country:US
Mailing Address - Phone:503-253-2248
Mailing Address - Fax:
Practice Address - Street 1:10201 SE MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2937
Practice Address - Country:US
Practice Address - Phone:503-253-2248
Practice Address - Fax:503-252-5166
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16116207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR041751Medicaid
OR041751Medicaid
ORR152663Medicare PIN
ORP00821473OtherRR MEDICARE
ORR103194Medicare ID - Type UnspecifiedMEDICARE