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General NPI Number Information
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NPI Number | 1538172119
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Entity Type | Individual
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Provider Name | WALTER L STANDRIDGE MD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 10180 SE SUNNYSIDE RD WING A
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City | CLACKAMAS
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State | OR
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Zip | 97015-8970
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Country | US
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Telephone | 503-571-0892
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Fax | 503-571-0867
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Provider Business Mailing Address
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Address Line | 10180 SE SUNNYSIDE RD WING A
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City | CLACKAMAS
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State | OR
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Zip | 97015-8970
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Country | US
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Telephone | 503-571-0892
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Fax | 503-571-0867
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 32903
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 32903
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License Number State | CO
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