Provider Demographics
NPI:1356314603
Name:PITTS, RYAN A (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:PITTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N BROADWAY ST STE 301
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-3355
Mailing Address - Country:US
Mailing Address - Phone:918-208-7497
Mailing Address - Fax:918-208-7687
Practice Address - Street 1:301 N BROADWAY ST STE 301
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-3355
Practice Address - Country:US
Practice Address - Phone:918-208-7497
Practice Address - Fax:918-208-7687
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3982207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H80707Medicare UPIN