Organization
RADIOLOGY SPECIALISTS OF THE NORTHWEST, PC
Active
Organization
RADIOLOGY SPECIALISTS OF THE NORTHWEST, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD KIZZIAR MD (PRESIDENT)
(503) 731-2900
Entity
Organization
Contact information
Practice address
545 NE 47TH AVE, SUITE 215, PORTLAND, OR 97213-2238
(503) 731-2900
Mailing address
PO BOX 4000-21, PORTLAND, OR 97208
(503) 731-2900
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227689
—
OR
05
—
7130669
—
WA
01
—
840126000
REGENCE BCBS
OR
Enumeration date
12/05/2005
Last updated
08/16/2010
Update your record
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