Provider Demographics
NPI:1346372760
Name:ZELLER, RYAN P (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:P
Last Name:ZELLER
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 1:230 BRET HARTE AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-2610
Mailing Address - Country:US
Mailing Address - Phone:775-219-6849
Mailing Address - Fax:775-624-2211
Practice Address - Street 1:2205 GLENDALE AVE
Practice Address - Street 2:#131
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5511
Practice Address - Country:US
Practice Address - Phone:775-331-3361
Practice Address - Fax:775-331-4719
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1262OtherMEDICAL LISENCE
NV1262OtherMEDICAL LISENCE