Provider Demographics
NPI:1699834713
Name:RYAN, COLMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:COLMAN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SOUTHGATE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2259
Mailing Address - Country:US
Mailing Address - Phone:650-991-1085
Mailing Address - Fax:650-758-4834
Practice Address - Street 1:1500 SOUTHGATE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2259
Practice Address - Country:US
Practice Address - Phone:650-991-1085
Practice Address - Fax:650-758-4834
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26490207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75309ZMedicaid
CAZZZ75309ZMedicare ID - Type Unspecified
CAZZZ75309ZMedicaid