Provider Demographics
NPI:1154357267
Name:SWAN, RYAN THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:THOMAS
Last Name:SWAN
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:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0128
Mailing Address - Country:US
Mailing Address - Phone:281-833-3330
Mailing Address - Fax:281-833-3323
Practice Address - Street 1:5715 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4322
Practice Address - Country:US
Practice Address - Phone:307-268-7731
Practice Address - Fax:307-265-2860
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6809A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYP00049310OtherRAILROAD MEDICARE
WY312302OtherBLUE SHIELD
WY118696500OtherWYOMING MEDICAID
WY114068000Medicaid
WY314031OtherBLUE CROSS
BS8212261OtherDEA
WY312302OtherBLUE SHIELD
WYH88434Medicare UPIN