Provider Demographics
NPI:1366482929
Name:RYAN, LAWRENCE R (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:R
Last Name:RYAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 41908
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-1908
Mailing Address - Country:US
Mailing Address - Phone:602-973-3100
Mailing Address - Fax:602-973-0978
Practice Address - Street 1:6677 W. THUNDERBIRD ROAD
Practice Address - Street 2:C-142
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3760
Practice Address - Country:US
Practice Address - Phone:623-247-1081
Practice Address - Fax:623-247-2962
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-04-06
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Provider Licenses
StateLicense IDTaxonomies
AZ2014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ263814Medicaid
AZD47148Medicare UPIN