Provider Demographics
NPI:1235896804
Name:COVEY, RYAN LOUIS
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LOUIS
Last Name:COVEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 NW 43RD AVE APT 441
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4127
Mailing Address - Country:US
Mailing Address - Phone:480-881-9055
Mailing Address - Fax:
Practice Address - Street 1:811 NW 43RD AVE APT 441
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4127
Practice Address - Country:US
Practice Address - Phone:480-881-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN195362163WS0200X
AZ303784207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No163WS0200XNursing Service ProvidersRegistered NurseSchool