RYAN D PEDERSON (NPI# 1063605384) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063605384 |
| Entity Type | Individual |
| Full Name | RYAN D PEDERSON |
| Credential | D.P.M. |
| Practice Address |
1900 Woodland Dr Coos Bay OR 97420-2099 |
| Practice Telephone | 5412675151 |
| Practice Fax Number | 5412664506 |
| Mailing Telephone | 5412695151 |
| Mailing Fax Number | 5412664506 |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2020-03-30 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
DP151127 | OR | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500623170 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568637742 | Ryan Pederson | Specialist/Technologist | 13322 Excalibur Rd, Clermont, FL 34711-6695 | 2008-04-28 |
| 1538713235 | Ryan A Pederson | Pharmacist | 4027 County Road 25, Suite P, Saint Louis Park, MN 55416 | 2019-07-31 |
| Street Address |
1900 WOODLAND DR |
| City | COOS BAY |
| State | OR |
| Zip Code | 97420-2099 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174517528 | Mary Irene Hernandez | Physical Therapist | 1900 Woodland Dr, Coos Bay, OR 97420 | 2005-08-31 |
| 1477189009 | Sandy Lynn Teeter | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2020-03-16 |
| 1114564630 | Mitaliben Rajendrakumar Gor | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2019-12-03 |
| 1568014942 | Nikkona Henderson | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2019-07-15 |
| 1861050189 | James Murray | Dermatology | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2019-06-01 |
| 1346803640 | Sophia Elizabeth Massey | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2019-04-22 |
| 1750857090 | Alaina Therese Hendrix | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2018-10-14 |
| 1801382155 | Yulia Viktorovna Whidden | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2018-07-10 |
| 1124525043 | Samantha Decker | Dermatology | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2018-04-07 |
| 1043712383 | Gregory Sopka | Physician Assistant | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2018-03-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346880606 | Danielle Goette | Massage Therapist | 320 Central Ave Suite 226, Coos Bay, OR 97420 | 2020-01-14 |
| 1730643735 | Nicole Hand-therapeutic Massage | Massage Therapist | 3229 Broadway Avenue, Suite D, Coos Bay, OR 97420 | 2019-01-24 |
| 1528531100 | A Better Reality | Clinic/Center | 2690 N. 17th Sstreet, Coos Bay, OR 97420 | 2019-01-07 |
| 1396216883 | Elizabeth Rose Stephens | Health Educator | 97381 Newport Lane, Coos Bay, OR 97420 | 2018-12-10 |
| 1093263386 | Megan Smith | Physician Assistant | 375 Park Ave Ste 5, Coos Bay, OR 97420 | 2016-09-14 |
| 1285091884 | Richard T Rigney | Counselor | 62754 Karl Road, Coos Bay, OR 97420 | 2016-01-27 |
| 1821493032 | James Thomas Agee | Pharmacist | 2051 Newmark Avenue, Walmart Pharmacy 1880, Coos Bay, OR 97420 | 2014-10-30 |
| 1346663895 | Steven D. Richardson D.m.d. L.l.c | Dentist | 1835 Ocean Blvd Se, Coos Bay, OR 97420 | 2014-02-03 |
| 1144669243 | Michael Jason Cole | Pharmacist | 1020 South First Ave, Coos Bay, OR 97420 | 2013-06-21 |
| 1639518053 | Jonathan Thomas Small | Physical Therapist | 2645 North 17th St, Coos Bay, OR 97420 | 2013-06-19 |
| Find all providers in zip 97420 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003432204 | Frontier Foot and Ankle Specialists LLC | Podiatrist | 780 2nd St Se # 10, Bandon, OR 97411-8354 | 2020-06-23 |
| 1710436662 | Hermiston Family Foot Clinic LLC | Podiatrist | 1050 W Elm Ave Ste 170, Hermiston, OR 97838-2715 | 2016-10-03 |
| 1255784492 | Sunny Sajjad | Podiatrist | 4905 River Rd N, Keizer, OR 97303-4539 | 2016-07-22 |
| 1285080556 | Sean Westover | Podiatrist | 1227 Ne 7th St Ste A, Grants Pass, OR 97526-1430 | 2016-05-05 |
| 1659774792 | Heather Keeler | Podiatrist | 1880 Willamette Falls Dr Ste 111, West Linn, OR 97068-4653 | 2014-10-03 |
| 1386051803 | Southwest Podiatry Center LLC | Podiatrist | 9370 Sw Greenburg Rd Ste 102, Portland, OR 97223-5428 | 2014-07-16 |
| 1578980694 | Amy Theppote | Podiatrist | 6542 Se Lake Rd Ste 102, Milwaukie, OR 97222-2245 | 2014-03-26 |
| 1144576224 | Trevor J Haynes | Podiatrist | 39400 Pioneer Blvd Ste 4, Sandy, OR 97055-8000 | 2012-07-26 |
| 1922379379 | John S Balknap Dpm PC | Podiatrist | 1716 E 12th St, The Dalles, OR 97058-3137 | 2012-01-17 |
| 1407145568 | Justin T Johnson Dpm Inc. | Podiatrist | 1661 Hwy 99 N Ste 201, Ashland, OR 97520-8900 | 2011-03-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.