Provider Demographics
NPI:1710178439
Name:BISBEY, RYAN J (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:BISBEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-371-2390
Mailing Address - Fax:814-371-9532
Practice Address - Street 1:529 SUNFLOWER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2378
Practice Address - Country:US
Practice Address - Phone:814-371-2390
Practice Address - Fax:814-371-9532
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439018207W00000X
PAMT189009207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025058480001Medicaid
PA1025058480001Medicaid