Provider Demographics
NPI:1033287172
Name:RYER, DAVID DANE (NP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DANE
Last Name:RYER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5211
Mailing Address - Country:US
Mailing Address - Phone:508-235-7300
Mailing Address - Fax:
Practice Address - Street 1:49 HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5211
Practice Address - Country:US
Practice Address - Phone:508-235-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226766363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z141499Medicare PIN
P15369Medicare UPIN
AZ894966Medicaid