Provider Demographics
NPI:1295172716
Name:VELLINGA, RYAN M (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:VELLINGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-814-6451
Mailing Address - Fax:360-445-8592
Practice Address - Street 1:3823 172ND ST NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7735
Practice Address - Country:US
Practice Address - Phone:360-435-6641
Practice Address - Fax:360-618-7663
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60942874207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery