Provider Demographics
NPI:1912374463
Name:RYAN, CURTIS
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:RYAN
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 1:1909 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-6151
Mailing Address - Country:US
Mailing Address - Phone:256-734-4688
Mailing Address - Fax:
Practice Address - Street 1:1909 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-6151
Practice Address - Country:US
Practice Address - Phone:256-734-4688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000025Medicaid