Standridge, Walter L

Standridge, Walter L is an individual health care provider with primary practice located at 10180 Se Sunnyside Rd Wing A, Clackamas OR 97015-8970. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Psychiatry is his primary health care specialty. Standridge, Walter L can be contacted via phone (503) 571-0892.

Contact Information

Primary practice address
10180 Se Sunnyside Rd Wing A Clackamas OR 97015-8970
Phone: (503) 571-0892
Fax: (503) 571-0867
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 32903 Colorado
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X 32903 Colorado

Profile Details

NPI number 1538172119
LBN Legal business name Standridge, Walter L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 14th, 2006
Last updated Aug 26th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538172119 NPPES
Colorado MEDICAID 12300063

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