Provider Demographics
NPI:1821885385
Name:DILLARD, RYAN JACOB (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JACOB
Last Name:DILLARD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 N BRENTFIELD DR APT 109N
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-9305
Mailing Address - Country:US
Mailing Address - Phone:541-817-5928
Mailing Address - Fax:
Practice Address - Street 1:12300 N BRENTFIELD DR APT 109N
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:IL
Practice Address - Zip Code:61525-9305
Practice Address - Country:US
Practice Address - Phone:541-817-5928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program