Provider Demographics
NPI:1457516288
Name:WASSENAAR, RYAN CONWAY (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CONWAY
Last Name:WASSENAAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:119 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7965
Mailing Address - Country:US
Mailing Address - Phone:865-804-1902
Mailing Address - Fax:
Practice Address - Street 1:990 OAK RIDGE TPKE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6976
Practice Address - Country:US
Practice Address - Phone:865-835-4304
Practice Address - Fax:865-835-4303
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ007164207R00000X
TN2067208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine