Provider Demographics
NPI:1134418049
Name:CARR, RYAN MATTHEW (PA-C)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:MATTHEW
Last Name:CARR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1625
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-1625
Mailing Address - Country:US
Mailing Address - Phone:928-645-1700
Mailing Address - Fax:928-645-1701
Practice Address - Street 1:440 N. NAVAJO DR.
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040
Practice Address - Country:US
Practice Address - Phone:928-645-1700
Practice Address - Fax:928-645-1701
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z145644Medicare PIN