Provider Demographics
NPI:1417449885
Name:RYZHKOVA, LORA (MD)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:
Last Name:RYZHKOVA
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 1:103 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-5008
Mailing Address - Country:US
Mailing Address - Phone:865-435-1933
Mailing Address - Fax:
Practice Address - Street 1:103 BENNETT RD
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-5008
Practice Address - Country:US
Practice Address - Phone:865-435-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10062854207Q00000X
TN64059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ069770Medicaid