Provider Demographics
NPI:1316922602
Name:JANY, RICHARD STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STEPHEN
Last Name:JANY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4541
Practice Address - Street 1:600 RANCH RD
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467-1720
Practice Address - Country:US
Practice Address - Phone:541-271-2171
Practice Address - Fax:541-271-6322
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16946207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200045913OtherRR MEDICARE PTAN NUMBER
OR011622Medicaid
OR0577260001OtherDMERC NUMBER
OR011622Medicaid
OR200045913OtherRR MEDICARE PTAN NUMBER
OR930635514OtherGROUP TAX ID NUMBER
ORCB3544OtherRR MEDICARE GROUP NUMBER
OR200045913OtherRR MEDICARE PTAN NUMBER
ORR101842Medicare PIN
OR930635514OtherGROUP TAX ID NUMBER