Provider Demographics
NPI:1063457109
Name:RYAN, ADRIAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:B
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3831 PIPER ST
Mailing Address - Street 2:SUITE S-220
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4672
Mailing Address - Country:US
Mailing Address - Phone:907-563-3145
Mailing Address - Fax:907-561-3967
Practice Address - Street 1:3831 PIPER ST
Practice Address - Street 2:SUITE S-220
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4672
Practice Address - Country:US
Practice Address - Phone:907-563-3145
Practice Address - Fax:907-561-3967
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK2567207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD01731Medicaid
E59252Medicare UPIN
AKMD01731Medicaid