Provider Demographics
NPI:1063029684
Name:GEBO, RYAN JOHN (RD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JOHN
Last Name:GEBO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-2346
Mailing Address - Country:US
Mailing Address - Phone:774-641-4193
Mailing Address - Fax:
Practice Address - Street 1:51 PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:ACUSHNET
Practice Address - State:MA
Practice Address - Zip Code:02743-2346
Practice Address - Country:US
Practice Address - Phone:774-641-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3847133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered