Healthcare Provider Details

I. General information

NPI: 1780903708
Provider Name (Legal Business Name): RYAN R. STEVENS, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/01/2010
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

1867 NW KINGS BLVD
CORVALLIS OR
97330-1907
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RYAN R STEVENS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 541-757-4999