Provider Demographics
NPI:1346932696
Name:LOBDELL, RYAN (CRM)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LOBDELL
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1450
Mailing Address - Country:US
Mailing Address - Phone:541-238-4728
Mailing Address - Fax:
Practice Address - Street 1:3206 ONYX AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-7279
Practice Address - Country:US
Practice Address - Phone:154-136-3127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000109035175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist