Provider Demographics
NPI:1336324169
Name:RYAN, PATRICK KEITH (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:KEITH
Last Name:RYAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:111 DOCTOR CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6502
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:
Practice Address - Street 1:4600 OLEANDER DR STE C
Practice Address - Street 2:AGAPE PHYSICIANS CARE
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5897
Practice Address - Country:US
Practice Address - Phone:843-448-2228
Practice Address - Fax:855-868-8450
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL0148OtherMEDICAID NUMBER
SC570941629OtherBCBS
SCTL0148OtherMEDICAID NUMBER
SC570941629OtherBCBS
SCTL0148OtherMEDICAID NUMBER