Provider Demographics
NPI:1205817632
Name:RYAN, JAMES P IV (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:RYAN
Suffix:IV
Gender:M
Credentials:MD
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Mailing Address - Street 1:1405 S ORANGE AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2153
Mailing Address - Country:US
Mailing Address - Phone:407-649-1097
Mailing Address - Fax:407-841-3786
Practice Address - Street 1:1405 S ORANGE AVE STE 601
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2153
Practice Address - Country:US
Practice Address - Phone:407-649-1097
Practice Address - Fax:407-841-3786
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2022-09-22
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Provider Licenses
StateLicense IDTaxonomies
FLME42232207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068941600Medicaid
FLD65213Medicare UPIN
FL59922XMedicare PIN
FL59922ZMedicare PIN
FL59922YMedicare PIN