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General NPI Number Information
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NPI Number | 1932005857
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Entity Type | Individual
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Provider Name | RYAN WAYNE FALCONER
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Gender |
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Dates
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Enumeration Date | 10/16/2026
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Last Update Date | 10/16/2026
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Provider Practice Location Address
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Address Line | 1200 NW NAITO PKWY STE 310
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City | PORTLAND
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State | OR
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Zip | 97209-2829
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Country | US
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Telephone | 503-241-9201
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Fax |
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Provider Business Mailing Address
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Address Line | 17183 SW BERKELEY LN
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City | BEAVERTON
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State | OR
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Zip | 97003-4232
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Country | US
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Telephone |
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Fax |
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 167021
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License Number State |
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