Active NPI
Douglas Newell Runckel, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Portland, OR
National Provider Identifier
1508974932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- OR MD09235
- Practice address
- 13705 NE Airport Way Ste C
Portland, OR 97230-1048 - Phone
- (503) 258-6846
- Fax
- (503) 258-6864
- NPI assigned
- Aug 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | OR MD09235 | OR | Primary |
Addresses
Primary practice location
13705 NE Airport Way Ste C
Portland, OR 97230-1048
Mailing address
3419 Pringle Rd SE
Salem, OR 97302-2649
Phone (503) 370-8988
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OR MD09235 | OR | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508974932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3419 PRINGLE RD SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973022649",
"telephone_number": "503-370-8988",
"fax_number": "503-258-6864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13705 NE AIRPORT WAY STE C",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972301048",
"telephone_number": "503-258-6846",
"fax_number": "503-258-6864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUNCKEL",
"first_name": "DOUGLAS",
"middle_name": "NEWELL",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "OR",
"license": "OR MD09235",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.