Provider Demographics
NPI:1083653653
Name:CYRAN, STANLEY J III (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:J
Last Name:CYRAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3159
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:5330 NE GLISAN ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3069
Practice Address - Country:US
Practice Address - Phone:503-215-9080
Practice Address - Fax:503-215-9099
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039772207N00000X
ORMD126216207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500609570Medicaid
ORP00795105OtherRR MEDICARE
WA8277832Medicaid
WAAB22579Medicare PIN
ORP00795105OtherRR MEDICARE
E92814Medicare UPIN
WAE92814Medicare UPIN