Provider Demographics
NPI:1467664839
Name:SCHNADIG, IAN DENISON (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:DENISON
Last Name:SCHNADIG
Suffix:
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 1:19260 SW 65TH AVE
Mailing Address - Street 2:SUITE 435
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-5701
Mailing Address - Country:US
Mailing Address - Phone:503-692-2032
Mailing Address - Fax:503-692-4450
Practice Address - Street 1:19260 SW 65TH AVE
Practice Address - Street 2:SUITE 435
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-5701
Practice Address - Country:US
Practice Address - Phone:503-692-2032
Practice Address - Fax:503-692-4450
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD150796207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2005439Medicaid
OR500618430Medicaid
OR500618430Medicaid
ORR153538Medicare PIN