Provider Demographics
NPI:1487679528
Name:SCOTT, RYAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:G
Last Name:SCOTT
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 1:18380 WILLAMETTE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1200
Mailing Address - Country:US
Mailing Address - Phone:503-635-8384
Mailing Address - Fax:503-636-6475
Practice Address - Street 1:18380 WILLAMETTE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1200
Practice Address - Country:US
Practice Address - Phone:503-635-8384
Practice Address - Fax:503-636-6475
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR001785004OtherBLUE CROSS
OR97068A007OtherCHAMPUS
OR135070Medicaid
OR104322Medicare ID - Type Unspecified
ORG62963Medicare UPIN