Healthcare Provider Details

I. General information

NPI: 1144260738
Provider Name (Legal Business Name): JAMES EDWARD BRYAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 SE STARK ST
PORTLAND OR
97233-1058
US

IV. Provider business mailing address

12600 SE STARK ST
PORTLAND OR
97233-1058
US

V. Phone/Fax

Practice location:
  • Phone: 503-284-8558
  • Fax: 503-335-1448
Mailing address:
  • Phone: 503-284-8558
  • Fax: 503-335-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number991
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: