Provider Demographics
NPI:1497791958
Name:RILEY, SYLVIA GIBSON (MD)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:GIBSON
Last Name:RILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 NE 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-4896
Mailing Address - Country:US
Mailing Address - Phone:360-882-2778
Mailing Address - Fax:
Practice Address - Street 1:700 NE 87TH AVE STE 220
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1913
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:360-604-1767
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21798207R00000X, 208M00000X
WAMD60824725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2000337Medicaid
ORP00472708OtherRR MEDICARE - PH&S - OREGON (PMG)
ORR136428Medicare PIN
ORR148049Medicare PIN
ORP00472708OtherRR MEDICARE - PH&S - OREGON (PMG)
ORR158404Medicare PIN