Provider Demographics
NPI:1013322759
Name:RYAN, RANDI J (MD)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:J
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5171 S COTTONWOOD ST STE 650
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5716
Mailing Address - Country:US
Mailing Address - Phone:801-507-9600
Mailing Address - Fax:801-507-9601
Practice Address - Street 1:5171 S COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-5704
Practice Address - Country:US
Practice Address - Phone:801-507-9600
Practice Address - Fax:801-507-9601
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT13573891-8905204F00000X
MN69603204F00000X
KS94-08447208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery