Provider Demographics
NPI:1326251182
Name:ROE, RYAN (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:ROE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50306-1475
Mailing Address - Country:US
Mailing Address - Phone:515-247-3266
Mailing Address - Fax:515-643-8688
Practice Address - Street 1:411 LAUREL ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3017
Practice Address - Country:US
Practice Address - Phone:515-247-3266
Practice Address - Fax:515-643-8688
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3522208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA53273OtherWELLMARK BLUE SHIELD
IA253422OtherMIDLANDS CHOICE
IA53273OtherWELLMARK BLUE SHIELD