Provider Demographics
NPI:1093859621
Name:RYAN L ALLEN DO INC
Entity Type:Organization
Organization Name:RYAN L ALLEN DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:805-348-3910
Mailing Address - Street 1:2342 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1629
Mailing Address - Country:US
Mailing Address - Phone:805-348-3910
Mailing Address - Fax:805-348-3901
Practice Address - Street 1:2342 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1629
Practice Address - Country:US
Practice Address - Phone:805-348-3910
Practice Address - Fax:805-348-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W21374Medicare PIN