Organization
LONGVIEW FOOT & ANKLE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAY A MCCLANAHAN DPM (OWNER)
(360) 575-9161
Entity
Organization
Contact information
Practice address
783 COMMERCE AVE, SUITE 120, LONGVIEW, WA 98632
(360) 575-9161
(360) 575-9306
Mailing address
725 NW 19TH AVE, PORTLAND, OR 97209-1301
(503) 243-2699
(503) 243-2698
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
DP00317
OR
213E00000X
Podiatrist
Primary
PO00000596
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1101682
—
WA
01
—
129510
L&I
WA
01
—
8397218
DMERC DSHS
WA
01
—
MC5942
REGENCE RIDER
WA
Enumeration date
10/04/2006
Last updated
03/26/2008
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