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1114283561
RYAN WALLENBERG
PORTLAND, OR
NPI
1114283561
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2012-04-10
Last Update Date
2012-04-10
Business Address
-- RYAN WALLENBERG M.D.
3181 SW SAM JACKSON PARK ROAD
PORTLAND, OR 97239
Phone number: 503-494-8211
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Mailing Address
-- RYAN WALLENBERG M.D.
1623 S TAVERNER DR
RIDGEFIELD, WA 98642
Phone number:
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