Basic Information
| Provider Information | |||||||||
| NPI: | 1093193492 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRILAEFF | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | RUSSELL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19020 33RD AVE W | ||||||||
| Address2: | STE 210 | ||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980364748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255631500 | ||||||||
| FaxNumber: | 4255631374 | ||||||||
| Practice Location | |||||||||
| Address1: | 1615 DELAWARE ST | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986322367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604142000 | ||||||||
| FaxNumber: | 3605142663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2015 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD61137566 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | MD61137566 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0438976 | 01 | WA | L & I - RADIA | OTHER | 0438998 | 01 | WA | L & I - VANCOUVER RADIOLOGISTS | OTHER | 0438978 | 01 | WA | L & I - RADIA | OTHER | 0438985 | 01 | WA | L & I - SWEDISH RADIA | OTHER | 2180065 | 05 | WA | MEDICAID | 0438989 | 01 | WA | L & I - EVERGREEN RADIA | OTHER | 0438994 | 01 | WA | L & I - SOUTH SOUND RADIOLOGY | OTHER | 0438996 | 01 | WA | L & I - SEATTLE RADIOLOGY | OTHER |