Provider Demographics
NPI:1407825813
Name:LOYD, RYAN D (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:D
Last Name:LOYD
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:2600 FERRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3055
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-8156
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002936A208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9397235OtherPHCS PID NUMBER
IN200533290Medicaid
IN000000375431OtherANTHEM PROVIDER NUMBER
IN11494873OtherCAQH NUMBER
IN9397235OtherPHCS PID NUMBER
INI43202Medicare UPIN
IN200533290Medicaid
INP00250568Medicare PIN
IN815490DDDDMedicare PIN