Provider Demographics
NPI:1073695698
Name:RYAN, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:8530 W SUNSET RD
Mailing Address - Street 2:#230
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2215
Mailing Address - Country:US
Mailing Address - Phone:702-483-4483
Mailing Address - Fax:702-483-4493
Practice Address - Street 1:8530 SUNSET ROAD
Practice Address - Street 2:#230
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103
Practice Address - Country:US
Practice Address - Phone:702-483-4483
Practice Address - Fax:702-483-4493
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14069207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1073695698Medicaid
NVCO685YMedicare PIN
CAH11796Medicare UPIN
NV1073695698Medicaid