Provider Demographics
NPI:1023300340
Name:FARRIS, RYAN (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:FARRIS
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 1:272 LONDON MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-6601
Mailing Address - Country:US
Mailing Address - Phone:606-877-2850
Mailing Address - Fax:606-877-2857
Practice Address - Street 1:272 LONDON MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6601
Practice Address - Country:US
Practice Address - Phone:606-877-2850
Practice Address - Fax:606-877-2857
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine