Provider Demographics
NPI:1356563381
Name:DENHAESE, RYAN PETER (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PETER
Last Name:DENHAESE
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 1:19 LIMESTONE DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7091
Mailing Address - Country:US
Mailing Address - Phone:716-634-3500
Mailing Address - Fax:716-634-3525
Practice Address - Street 1:19 LIMESTONE DR
Practice Address - Street 2:SUITE 11
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7091
Practice Address - Country:US
Practice Address - Phone:716-634-3500
Practice Address - Fax:716-634-3525
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY243525-1207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program