Provider Demographics
NPI:1740285832
Name:RYNERSON, JAMES MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:RYNERSON
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 1:405 S L ROGERS WELLS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1725
Mailing Address - Country:US
Mailing Address - Phone:270-651-0439
Mailing Address - Fax:270-651-3991
Practice Address - Street 1:317 SEVEN SPRINGS WAY STE 104
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4576
Practice Address - Country:US
Practice Address - Phone:615-637-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000032268207W00000X
KY28184207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY180033104OtherRAILROAD MEDIARE
KY64281843Medicaid
KY000000069310OtherANTHEM BCBS
KY64281843Medicaid
KY0750701Medicare ID - Type Unspecified