Provider Information for 1720385669
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Mr. RYAN DOUGLAS BAIR LCSW
Sex: Male
NPI: 1720385669
Last Updated: 2018-03-17
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1720385669 | ||||||||
| Enumeration Date | 2011-02-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 900 E MAIN ST MEDFORD, OR 97504-7136 United States Phone: 541-842-7704 | Fax:541-842-7640 | ||||||||
| Primary Practice Address | 900 E MAIN ST MEDFORD, OR 97504-7136 United States Phone: 541-842-7704 | Fax:541-842-7640 | ||||||||
| Secondary Practice Address(es) | 1020 S CONWELL ST 1020 S CONWELL ST | ||||||||
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