Provider Demographics
NPI:1700945607
Name:GWINN, RYDER P (MD)
Entity Type:Individual
Prefix:
First Name:RYDER
Middle Name:P
Last Name:GWINN
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:PO BOX 84026
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-8426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY
Practice Address - Street 2:STE 901
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4396
Practice Address - Country:US
Practice Address - Phone:206-386-3880
Practice Address - Fax:206-386-3882
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043991207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8403511Medicaid
WA0187914OtherLABOR AND INDUSTRIES
WA8805951Medicare ID - Type Unspecified
WAG8879164Medicare PIN
WA8403511Medicaid