Provider Demographics
NPI:1437402435
Name:LAW, RYAN MATTHEW (MACOM)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MATTHEW
Last Name:LAW
Suffix:
Gender:M
Credentials:MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 SUMMIT AVENUE
Mailing Address - Street 2:APT 514
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122
Mailing Address - Country:US
Mailing Address - Phone:206-310-0761
Mailing Address - Fax:
Practice Address - Street 1:1412 SUMMIT AVE
Practice Address - Street 2:APT 514
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3688
Practice Address - Country:US
Practice Address - Phone:206-310-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60311050171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist