Basic Information
| Provider Information | |||||||||
| NPI: | 1023077500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KARMY-JONES | ||||||||
| FirstName: | RIYAD | ||||||||
| MiddleName: | CARADOG | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8945 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986688945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605141854 | ||||||||
| FaxNumber: | 3605146063 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 N GRAHAM ST STE 125 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972271683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034133714 | ||||||||
| FaxNumber: | 5034132061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 12/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/13/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD00035499 | WA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | MD00035499 | WA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208G00000X | MD00035499 | WA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 8218794 | 05 | WA | MEDICAID |