Provider Demographics
NPI:1902901853
Name:RULON, MICHAEL PRESTON (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PRESTON
Last Name:RULON
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 1:691 MURPHY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4346
Mailing Address - Country:US
Mailing Address - Phone:541-779-3520
Mailing Address - Fax:541-779-3702
Practice Address - Street 1:691 MURPHY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4346
Practice Address - Country:US
Practice Address - Phone:541-779-3520
Practice Address - Fax:541-779-3702
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14214207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR272161Medicaid
ORMD14214OtherSTATE ID
OR000000008488OtherASANTE/HEALTH FUTURE
OR276148307118OtherLIFEWISE
OR272161Medicaid
OR276148307118OtherLIFEWISE