Healthcare Provider Details

I. General information

NPI: 1326028192
Provider Name (Legal Business Name): CHADLEY RYAN HUEBNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER SAN DIEGO 34520 BOB WILSON DRIVE
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

2092 CROSSWOODS CIR
OAK HARBOR WA
98277-8860
US

V. Phone/Fax

Practice location:
  • Phone: 760-704-7142
  • Fax:
Mailing address:
  • Phone: 360-675-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberA109814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: