Provider Demographics
NPI:1942233499
Name:RONEY, RYAN PM (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PM
Last Name:RONEY
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 1:2683 N SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3850
Mailing Address - Country:US
Mailing Address - Phone:503-710-4384
Mailing Address - Fax:
Practice Address - Street 1:2683 N SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-3850
Practice Address - Country:US
Practice Address - Phone:503-710-4384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26805207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1942233499Medicaid
ORP00479303OtherRR MEDICARE
WA8457939Medicaid
OR240515Medicaid
AKMD4311RMedicaid
WA8457939Medicaid
OR134873Medicare PIN