Provider Demographics
NPI:1831169010
Name:RYAN, PAUL HAROLD JR (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HAROLD
Last Name:RYAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1420 TARA HILLS DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2530
Mailing Address - Country:US
Mailing Address - Phone:510-724-5222
Mailing Address - Fax:510-724-4714
Practice Address - Street 1:1420 TARA HILLS DR
Practice Address - Street 2:SUITE D
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2530
Practice Address - Country:US
Practice Address - Phone:510-724-5222
Practice Address - Fax:510-724-4714
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2008-09-19
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Provider Licenses
StateLicense IDTaxonomies
CAG416820207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0225450001Medicare NSC
CAA48656Medicare UPIN
CA1831169010Medicare PIN