Provider Demographics
NPI:1114056652
Name:MANN, RYAN CARLTON (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CARLTON
Last Name:MANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 RIVER VIEW CV
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-4704
Mailing Address - Country:US
Mailing Address - Phone:205-807-5665
Mailing Address - Fax:
Practice Address - Street 1:840 MONTCLAIR RD STE 317
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1944
Practice Address - Country:US
Practice Address - Phone:205-592-5745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL121100Medicaid
AL121100Medicaid