Basic Information
Provider Information
NPI: 1447285689
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SYNA
FirstName: DEBORAH
MiddleName: RUTH
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3777
Address2:  
City: PORTLAND
State: OR
PostalCode: 972083777
CountryCode: US
TelephoneNumber: 5034133900
FaxNumber: 5034133710
Practice Location
Address1: 1040 NW 22ND AVE STE 420
Address2:  
City: PORTLAND
State: OR
PostalCode: 972103062
CountryCode: US
TelephoneNumber: 5034136166
FaxNumber: 3604874709
Other Information
ProviderEnumerationDate: 07/12/2006
LastUpdateDate: 12/21/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/21/2019

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XMD17926ORY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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