Provider Demographics
NPI:1356375398
Name:RYACK, PAUL R (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:RYACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6676
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93160-6676
Mailing Address - Country:US
Mailing Address - Phone:805-964-9858
Mailing Address - Fax:805-964-5935
Practice Address - Street 1:5333 HOLLISTER AVE
Practice Address - Street 2:#201
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2341
Practice Address - Country:US
Practice Address - Phone:805-964-9858
Practice Address - Fax:805-964-5935
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG020915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG20915Medicare ID - Type Unspecified
CAA65872Medicare UPIN