Provider Demographics
NPI:1780927988
Name:HEATH, RYAN D (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:D
Last Name:HEATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6400 W. NEWBERRY ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GAINSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-331-8902
Mailing Address - Fax:352-224-1094
Practice Address - Street 1:6400 W. NEWBERRY ROAD
Practice Address - Street 2:SUITE 302
Practice Address - City:GAINSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-331-8902
Practice Address - Fax:352-224-1094
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2018002921207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty