Provider Demographics
NPI:1396207387
Name:GALL, RYAN ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ANDREW
Last Name:GALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CRAG RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-7013
Mailing Address - Country:US
Mailing Address - Phone:586-214-2459
Mailing Address - Fax:
Practice Address - Street 1:350 CRAG RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-7013
Practice Address - Country:US
Practice Address - Phone:586-214-2459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2022-09-16
Deactivation Date:2019-05-13
Deactivation Code:
Reactivation Date:2019-05-29
Provider Licenses
StateLicense IDTaxonomies
VA0101270363208D00000X
FL159051208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice