Provider Demographics
NPI:1891019121
Name:HERBERT, RYAN LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LAWRENCE
Last Name:HERBERT
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 1:930 SW 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3812
Mailing Address - Country:US
Mailing Address - Phone:954-562-0831
Mailing Address - Fax:954-472-4132
Practice Address - Street 1:930 SW 93RD AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3812
Practice Address - Country:US
Practice Address - Phone:954-562-0831
Practice Address - Fax:954-472-4132
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine