Provider Demographics
NPI:1558459255
Name:RYAN, ALISSE M (MD)
Entity Type:Individual
Prefix:
First Name:ALISSE
Middle Name:M
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 1:1100 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-223-6600
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040027207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS2557076OtherAETNA SPECIALIST PIN
WA110225856OtherRAILROAD MEDICARE
AKMD2653WMedicaid
WA8284093Medicaid
WA0039581OtherLABOR AND INDUSTRIES #
WA9798RYOtherBLUE SHIELD #
WAUS2557076OtherAETNA SPECIALIST PIN
WA8801337Medicare PIN
WAAB22865Medicare PIN
AKMD2653WMedicaid