Provider Demographics
NPI:1033137641
Name:RYAN, KEVIN P (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2601 VILLAGE PROFESSIONAL DR N
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-4784
Mailing Address - Country:US
Mailing Address - Phone:334-528-5400
Mailing Address - Fax:334-528-5421
Practice Address - Street 1:2601 VILLAGE PROFESSIONAL DR N
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4784
Practice Address - Country:US
Practice Address - Phone:334-528-5400
Practice Address - Fax:334-528-5421
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.13442207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL05810009068OtherBLUE CROSS BLUE SHIELD
ALC71775Medicare UPIN
AL000009068Medicare ID - Type Unspecified