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General NPI Number Information
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NPI Number | 1053644179
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Entity Type | Individual
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Provider Name | ELIZABETH BOGEL RYAN MD
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Gender | Female
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 111 SW NAITO PKWY STE 200
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City | PORTLAND
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State | OR
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Zip | 97204-3512
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Country | US
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Telephone | 888-288-4710
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Fax | 833-260-2594
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Provider Business Mailing Address
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Address Line | 111 SW NAITO PKWY STE 200
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City | PORTLAND
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State | OR
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Zip | 97204-3512
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Country | US
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Telephone | 888-288-4710
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Fax | 833-260-2594
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 272489
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 2024-02178
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | MD218904
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | MD.MD.60239397
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | DR.0070137
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License Number State | CO
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Taxonomy #6
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 35.145681
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License Number State | OH
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Taxonomy #7
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 272489
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License Number State | NY
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