Provider Demographics
NPI:1184828410
Name:RYAN, JOHN GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GERARD
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4466 OLIVE ST
Mailing Address - Street 2:SUITE #301
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1808
Mailing Address - Country:US
Mailing Address - Phone:314-533-3161
Mailing Address - Fax:
Practice Address - Street 1:MALLINCKRODT INSTITUTE OF RADIOLOGY - BARNESJEWISH HOSP
Practice Address - Street 2:510 SOUTH KINGSHIGHWAY BLVD.,
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-533-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20060282322085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging