Provider Demographics
NPI:1184071656
Name:CORPUZ, RYAN (RT(R)(ARRT))
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CORPUZ
Suffix:
Gender:M
Credentials:RT(R)(ARRT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 E HIGHWAY 3
Mailing Address - Street 2:APT 250G
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-5431
Mailing Address - Country:US
Mailing Address - Phone:707-688-3221
Mailing Address - Fax:
Practice Address - Street 1:1301 E HIGHWAY 3
Practice Address - Street 2:APT 250G
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-5431
Practice Address - Country:US
Practice Address - Phone:707-688-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN533372247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist