Provider Demographics
NPI:1659328391
Name:RYAN, SARAH A (MD)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:A
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:RUEFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2875 TINA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1582
Mailing Address - Country:US
Mailing Address - Phone:406-728-3366
Mailing Address - Fax:406-728-0651
Practice Address - Street 1:2875 TINA AVE STE 101
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1582
Practice Address - Country:US
Practice Address - Phone:406-728-3366
Practice Address - Fax:067-280-6514
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT127435208800000X, 2088F0040X
NV15436208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTI14548Medicare UPIN
MT000085136Medicare ID - Type Unspecified
MTP00300354Medicare PIN
MT000085411Medicare ID - Type Unspecified
WYW20821Medicare PIN