Provider Demographics
NPI:1609187392
Name:THOMAS, RYAN CHRISTIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CHRISTIAN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DPM
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:480 REDWOOD ST
Mailing Address - Street 2:10
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-2958
Mailing Address - Country:US
Mailing Address - Phone:707-643-3687
Mailing Address - Fax:
Practice Address - Street 1:480 REDWOOD ST
Practice Address - Street 2:SUITE 10
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-2958
Practice Address - Country:US
Practice Address - Phone:707-643-3687
Practice Address - Fax:707-643-3077
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2016-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE 5084213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery