Provider Demographics
NPI:1093193492
Name:STRILAEFF, RYAN RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RUSSELL
Last Name:STRILAEFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W
Mailing Address - Street 2:STE 210
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2367
Practice Address - Country:US
Practice Address - Phone:360-414-2000
Practice Address - Fax:360-514-2663
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD611375662085R0202X, 2085R0204X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0438976OtherL & I - RADIA
WA0438998OtherL & I - VANCOUVER RADIOLOGISTS
WA0438978OtherL & I - RADIA
WA0438985OtherL & I - SWEDISH RADIA
WA2180065Medicaid
WA0438989OtherL & I - EVERGREEN RADIA
WA0438994OtherL & I - SOUTH SOUND RADIOLOGY
WA0438996OtherL & I - SEATTLE RADIOLOGY