Provider Demographics
NPI:1851641443
Name:OREBAUGH, RYAN LEE
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LEE
Last Name:OREBAUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1216
Mailing Address - Country:US
Mailing Address - Phone:907-317-4821
Mailing Address - Fax:
Practice Address - Street 1:3722 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1216
Practice Address - Country:US
Practice Address - Phone:907-317-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other