Provider Demographics
NPI:1720396153
Name:RYAN, MICHAEL PARRAMORE (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PARRAMORE
Last Name:RYAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1261 COUNTRY MILE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7860
Mailing Address - Country:US
Mailing Address - Phone:480-606-8403
Mailing Address - Fax:
Practice Address - Street 1:1912 W 930 N
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-4104
Practice Address - Country:US
Practice Address - Phone:801-922-9372
Practice Address - Fax:801-922-9370
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT77698081206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant