Individual
RYAN C PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1151 MAY ST, HOOD RIVER, OR 97031-1552
(541) 399-7552
Mailing address
PO BOX 3390, PORTLAND, OR 97208-3390
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD24586
OR
208M00000X
Hospitalist Physician
Primary
MD24586
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227352
—
OR
Enumeration date
09/27/2006
Last updated
04/03/2017
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