Provider Demographics
NPI:1417016312
Name:CONLEY, RYAN PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:CONLEY
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 1:3131 MILITARY BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2290
Mailing Address - Country:US
Mailing Address - Phone:918-687-6600
Mailing Address - Fax:918-687-6610
Practice Address - Street 1:3131 MILITARY BLVD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2290
Practice Address - Country:US
Practice Address - Phone:918-687-6600
Practice Address - Fax:918-687-6610
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4394207P00000X, 207W00000X
NY252363207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY686A01OtherEMPIRE BCBS
NYA400012080Medicare PIN
OKOKA101232Medicare PIN
NY686A01OtherEMPIRE BCBS