Provider Demographics
NPI:1861564676
Name:NATZKE, RICHARD H (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:NATZKE
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 1:2120 EXCHANGE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3364
Mailing Address - Country:US
Mailing Address - Phone:503-325-5360
Mailing Address - Fax:503-325-9373
Practice Address - Street 1:2120 EXCHANGE ST
Practice Address - Street 2:STE 200
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3364
Practice Address - Country:US
Practice Address - Phone:503-325-5360
Practice Address - Fax:503-325-9373
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 17548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR035829Medicaid
WA8133126Medicaid
WA8133126Medicaid
OR109147Medicare ID - Type Unspecified