Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | DO197759 | OR |
NPI | 1093194441 |
---|---|
Provider Name | Ryan D Thompson |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97225-6643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2015 |
Last Update Date | 16/02/2021 |