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Individual

DR. BRIAN D WADLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
233 NE 102ND AVE, PORTLAND, OR 97220-4106
(503) 535-8325
(503) 535-8399
Mailing address
233 NE 102ND AVE, PORTLAND, OR 97220-4106

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
31752
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1Z7050
HEALTH NET
AZ
05
792409
AZ
01
AZ0738560
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
05/05/2006
Last updated
08/26/2015
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