Individual
DR. RYAN E JOHANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1128 NE 2ND ST STE 104, CORVALLIS, OR 97330-6293
(541) 602-6211
Mailing address
PO BOX 2483, CORVALLIS, OR 97339-2483
(541) 602-6211
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD27209
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274438
—
OR
05
—
8487746
—
WA
01
—
P00784755
RR MEDICARE
OR
Enumeration date
07/26/2007
Last updated
04/07/2022
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