Healthcare Provider Details

I. General information

NPI: 1417938309
Provider Name (Legal Business Name): RYAN RICHARD STEVENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 NW KINGS BLVD
CORVALLIS OR
97330-1907
US

IV. Provider business mailing address

2378 NW HUNTINGTON DR
CORVALLIS OR
97330-9725
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-4999
  • Fax: 541-757-0800
Mailing address:
  • Phone: 541-745-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD22325
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: