Provider Demographics
NPI:1285635888
Name:GOLUB, RYAN B (DPM)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:B
Last Name:GOLUB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11209 N TATUM BLVD STE B100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3091
Mailing Address - Country:US
Mailing Address - Phone:602-973-3888
Mailing Address - Fax:602-973-3028
Practice Address - Street 1:11209 N TATUM BLVD STE B100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3091
Practice Address - Country:US
Practice Address - Phone:602-973-3888
Practice Address - Fax:602-973-3028
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0581213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0194890OtherBCBS
AZ2Z0183OtherHEALTH NET
AZU75204Medicare UPIN
AZZ75723Medicare ID - Type Unspecified
AZ4961410001Medicare NSC