Individual
RYAN GIBBONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2155 NW 173RD AVE, 103, BEAVERTON, OR 97006
(503) 330-1117
Mailing address
2155 NW 173RD AVE, 103, BEAVERTON, OR 97006-3563
(503) 330-1171
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10908
OR
Other
Enumeration date
02/14/2011
Last updated
02/14/2011
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