Provider Demographics
NPI:1134130131
Name:RYAN, DAVID NATHANIEL ARTHUR (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NATHANIEL ARTHUR
Last Name:RYAN
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 1:557 W 2600 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7717
Mailing Address - Country:US
Mailing Address - Phone:801-298-9155
Mailing Address - Fax:801-298-9156
Practice Address - Street 1:557 W 2600 S
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7717
Practice Address - Country:US
Practice Address - Phone:801-298-9155
Practice Address - Fax:801-298-9156
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO1000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51010106OtherBCBS
AL100604Medicaid
ALBR8737629OtherDEA
KSI28005Medicare UPIN
ALI28005Medicare UPIN