Provider Demographics
NPI:1740507359
Name:CALLAN, RYAN ROBERT (RYAN R CALLAN)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ROBERT
Last Name:CALLAN
Suffix:
Gender:M
Credentials:RYAN R CALLAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 E 21ST AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223
Mailing Address - Country:US
Mailing Address - Phone:509-714-7543
Mailing Address - Fax:
Practice Address - Street 1:210 W SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-714-7543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program