Individual
RYAN S CORDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1455 NW IRVING ST STE 600, PORTLAND, OR 97209-2277
(503) 684-8252
Mailing address
1314 NE EMERSON ST, PORTLAND, OR 97211-4311
(325) 276-1023
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA11572
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104334176
—
TX
Enumeration date
01/12/2018
Last updated
09/03/2020
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