Provider Demographics
NPI:1881663037
Name:EDWARDS, RYAN K (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:K
Last Name:EDWARDS
Suffix:
Gender:M
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:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:660-827-0505
Mailing Address - Fax:
Practice Address - Street 1:2301 S INGRAM AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-8121
Practice Address - Country:US
Practice Address - Phone:660-827-0505
Practice Address - Fax:660-826-4802
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7D08207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO509999207Medicaid
MOH996820Medicare PIN
MO509999207Medicaid
MO4232420001Medicare NSC