Provider Demographics
NPI:1205861200
Name:RYAN MCWHORTER MD LLC
Entity Type:Organization
Organization Name:RYAN MCWHORTER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MCWHORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-819-8190
Mailing Address - Street 1:239 MITYLENE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3547
Mailing Address - Country:US
Mailing Address - Phone:334-819-8190
Mailing Address - Fax:334-819-8195
Practice Address - Street 1:239 MITYLENE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3547
Practice Address - Country:US
Practice Address - Phone:334-819-8190
Practice Address - Fax:334-819-8195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529929380Medicaid
AL510-04097OtherPMD
AL510-04097OtherPMD