Provider Demographics
NPI:1619925559
Name:RYAN, TERRENCE J (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:J
Last Name:RYAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1605 E BROADWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8023
Mailing Address - Country:US
Mailing Address - Phone:573-815-4242
Mailing Address - Fax:573-815-4245
Practice Address - Street 1:1605 E BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8023
Practice Address - Country:US
Practice Address - Phone:573-815-4242
Practice Address - Fax:573-815-4245
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-07-22
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Provider Licenses
StateLicense IDTaxonomies
MO2006002066207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201333200Medicaid