Provider Demographics
NPI:1225588858
Name:ANLIKER, RYAN MATTHEW I (BS)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:MATTHEW
Last Name:ANLIKER
Suffix:I
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18151 WILLIAMS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:OR
Mailing Address - Zip Code:97544-9634
Mailing Address - Country:US
Mailing Address - Phone:541-415-4602
Mailing Address - Fax:
Practice Address - Street 1:18151 WILLIAMS HWY
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:OR
Practice Address - Zip Code:97544-9644
Practice Address - Country:US
Practice Address - Phone:541-415-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1683814-81744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213ES0000XMedicaid
OR302F00000XMedicaid
OR305R00000XMedicaid
OR305500000XMedicaid
OR347C00000XMedicaid
PA282NW0100XMedicaid
OR251T0000XMedicaid
OR3416AD800XMedicaid
OR25300000XMedicaid