Provider Demographics
NPI:1407943244
Name:RYAN, PATRICIA J (MD)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:J
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11036 OAK ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4826
Mailing Address - Country:US
Mailing Address - Phone:402-827-9450
Mailing Address - Fax:
Practice Address - Street 1:11036 OAK ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4826
Practice Address - Country:US
Practice Address - Phone:402-827-9450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE263219Medicare ID - Type Unspecified
NEE58945Medicare UPIN