Provider Demographics
NPI:1588664346
Name:RYAN, ROBYN G (MD)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:G
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:
Other - Last Name:GEMBOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6068
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0068
Mailing Address - Country:US
Mailing Address - Phone:402-484-9009
Mailing Address - Fax:402-483-4223
Practice Address - Street 1:7100 STEPHANIE LN STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5332
Practice Address - Country:US
Practice Address - Phone:402-484-9009
Practice Address - Fax:402-483-4223
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15654207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE7398OtherBLUE SHIELD
NE070013361OtherRAILROAD MEDICARE
NE47065843713Medicaid
B67898Medicare UPIN
NE273154Medicare PIN