Provider Demographics
NPI:1639167695
Name:RYAN, JOHN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E 2ND ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1181
Mailing Address - Country:US
Mailing Address - Phone:775-789-7000
Mailing Address - Fax:775-789-7040
Practice Address - Street 1:1500 E 2ND ST
Practice Address - Street 2:SUITE 206
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1181
Practice Address - Country:US
Practice Address - Phone:775-789-7000
Practice Address - Fax:775-789-7040
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5019208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC5339OtherBCBS
CAXPY039070Medicaid
C96534Medicare UPIN
CAXPY039070Medicaid