Provider Demographics
NPI:1710241054
Name:GEGG, RYAN (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:GEGG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MACK BAYOU LOOP STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-7194
Mailing Address - Country:US
Mailing Address - Phone:850-797-6191
Mailing Address - Fax:850-420-8342
Practice Address - Street 1:141 MACK BAYOU LOOP STE 102
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-7194
Practice Address - Country:US
Practice Address - Phone:850-797-6191
Practice Address - Fax:850-420-8342
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17209207K00000X, 207YX0905X
ALDO.1715207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology