Provider Demographics
NPI:1619034980
Name:DAVID M RYAN, D.O.
Entity Type:Organization
Organization Name:DAVID M RYAN, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-374-4166
Mailing Address - Street 1:1410 N PITTSBURG ST STE A
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8211
Mailing Address - Country:US
Mailing Address - Phone:509-374-4166
Mailing Address - Fax:509-374-4167
Practice Address - Street 1:1410 N PITTSBURG ST STE A
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8211
Practice Address - Country:US
Practice Address - Phone:509-374-4166
Practice Address - Fax:509-374-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128952Medicaid
WAGAB29419Medicare ID - Type Unspecified
WAE60508Medicare UPIN