Provider Demographics
NPI:1326076753
Name:RYAN, WILLIAM M (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:1010 SPRUCE ST
Practice Address - Street 2:ESPANOLA HOSPITAL
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2724
Practice Address - Country:US
Practice Address - Phone:505-367-0340
Practice Address - Fax:505-367-0346
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-03-24
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Provider Licenses
StateLicense IDTaxonomies
NM80-87207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00012815Medicaid
NMNMAAA0180Medicare PIN
D43290Medicare UPIN