Provider Demographics
NPI:1497965768
Name:KIRWAN, RYAN (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KIRWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 HIGHLAND BLVD STE 1180
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6905
Mailing Address - Country:US
Mailing Address - Phone:406-587-8631
Mailing Address - Fax:406-587-1343
Practice Address - Street 1:925 HIGHLAND BLVD
Practice Address - Street 2:STE 1180
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6905
Practice Address - Country:US
Practice Address - Phone:603-668-7096
Practice Address - Fax:603-669-6944
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT405922085R0202X
MTMED-PHYS-LIC-405922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011006023Medicare PIN
MT011006024Medicare PIN
WA0258163OtherL&I