Individual
DR. RYAN EDWIN CHILDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19250 SW 90TH AVE, TUALATIN, OR 97062-7585
(503) 692-3750
(503) 691-2324
Mailing address
847 NE 19TH AVE, SUITE 300, PORTLAND, OR 97232-2684
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
D74059
MD
207RG0100X
Gastroenterology Physician
Primary
MD162161
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055765000
—
MD
05
—
500678079
—
OR
Enumeration date
07/18/2008
Last updated
02/01/2017
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