Provider Demographics
NPI:1962658021
Name:BEARD, RYAN SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SAMUEL
Last Name:BEARD
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 1:1230 E 6TH AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-3145
Mailing Address - Country:US
Mailing Address - Phone:620-222-6264
Mailing Address - Fax:620-800-1011
Practice Address - Street 1:1230 E 6TH AVE STE 2C
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-3145
Practice Address - Country:US
Practice Address - Phone:620-222-6264
Practice Address - Fax:620-800-1011
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-38021207R00000X, 207RI0011X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP01497358OtherRAILROAD MEDICARE
KSP01497358OtherRAILROAD MEDICARE