Provider Demographics
NPI:1053644179
Name:RYAN, ELIZABETH BOGEL (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BOGEL
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:111 SW NAITO PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3512
Mailing Address - Country:US
Mailing Address - Phone:888-288-4710
Mailing Address - Fax:833-260-2594
Practice Address - Street 1:111 SW NAITO PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3512
Practice Address - Country:US
Practice Address - Phone:888-288-4710
Practice Address - Fax:833-260-2594
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2024-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY272489207Q00000X, 207QA0401X
NC2024-02178207QA0401X
ORMD218904207QA0401X
WAMD.MD.60239397207QA0401X
CODR.0070137207QA0401X
OH35.145681207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03802068Medicaid