Provider Demographics
NPI:1265698716
Name:NORRIS, RYAN KENNETH (DO)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:KENNETH
Last Name:NORRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3545 NW 58TH ST
Mailing Address - Street 2:STE 450
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4726
Mailing Address - Country:US
Mailing Address - Phone:405-951-4370
Mailing Address - Fax:
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:#2010
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-644-5120
Practice Address - Fax:405-644-5309
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-053038207R00000X
IL036.124250207RC0000X
OK5508207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5508OtherOKLAHOMA BOARD OF OSTEOPATHIC EXAMINERS