Individual
CODY RYAN CANTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
2445 BEVERLY ST STE B, SPRINGFIELD, OR 97477-1910
(541) 780-6654
Mailing address
2445 BEVERLY ST STE B, SPRINGFIELD, OR 97477-1910
(541) 780-6654
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA210353
OR
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA210353
OREGON MEDICAL LICENSE
OR
Enumeration date
03/09/2021
Last updated
07/08/2026
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