Provider Demographics
NPI:1851856363
Name:LAIDLAW, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LAIDLAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 CHANDLER DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1346
Mailing Address - Country:US
Mailing Address - Phone:419-371-1613
Mailing Address - Fax:
Practice Address - Street 1:1639 CHANDLER DR
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1346
Practice Address - Country:US
Practice Address - Phone:419-371-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program