Provider Demographics
NPI:1992865778
Name:RYAN, WILLIAM MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9155 SW BARNES RD
Mailing Address - Street 2:SUITE 733
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225
Mailing Address - Country:US
Mailing Address - Phone:503-292-0899
Mailing Address - Fax:503-292-1587
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:SUITE 733
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-292-0899
Practice Address - Fax:503-292-1587
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD 16725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR009733Medicaid
D79700Medicare UPIN
OR009733Medicaid