Provider Demographics
NPI:1942289467
Name:REILLY, RICHARD RYAN (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:RYAN
Last Name:REILLY
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:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-4910
Mailing Address - Fax:520-784-7226
Practice Address - Street 1:7510 N ORACLE RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4447
Practice Address - Country:US
Practice Address - Phone:520-324-4910
Practice Address - Fax:520-324-4911
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ23347Medicare ID - Type Unspecified
AZG71427Medicare UPIN