Provider Demographics
NPI:1568611606
Name:R. RYAN RAWLINGS, DO, PLC
Entity Type:Organization
Organization Name:R. RYAN RAWLINGS, DO, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:RAWLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-834-4860
Mailing Address - Street 1:PO BOX 25041
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85002-5041
Mailing Address - Country:US
Mailing Address - Phone:480-834-4860
Mailing Address - Fax:480-610-1756
Practice Address - Street 1:9001 N 28TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4702
Practice Address - Country:US
Practice Address - Phone:480-834-4860
Practice Address - Fax:480-610-1756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ101859Medicaid
H85510Medicare UPIN
AZ101859Medicaid