Provider Demographics
NPI:1639197452
Name:SMITH, RYAN GLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:GLEN
Last Name:SMITH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:280 SIERRA COLLEGE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5763
Mailing Address - Country:US
Mailing Address - Phone:530-477-4480
Mailing Address - Fax:530-477-3100
Practice Address - Street 1:280 SIERRA COLLEGE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5763
Practice Address - Country:US
Practice Address - Phone:530-477-4480
Practice Address - Fax:530-477-3100
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-01-19
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Provider Licenses
StateLicense IDTaxonomies
CAA74197207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease