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
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