Provider Demographics
NPI:1306024740
Name:DAILEY, RYAN WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:WILLIAM
Last Name:DAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MERCY HOSPITAL
Mailing Address - Street 2:4050 COON RAPIDS BLVD
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2522
Mailing Address - Country:US
Mailing Address - Phone:763-236-9429
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-2300
Practice Address - Fax:612-904-4363
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine