Provider Demographics
NPI:1912918129
Name:RYAN, DAVID MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:RYAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1410 N PITTSBURGH ST
Mailing Address - Street 2:BLDG. A
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8211
Mailing Address - Country:US
Mailing Address - Phone:509-374-4166
Mailing Address - Fax:509-374-4167
Practice Address - Street 1:1410 N PITTSBURG ST
Practice Address - Street 2:BLDG. A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8211
Practice Address - Country:US
Practice Address - Phone:509-374-4166
Practice Address - Fax:509-374-4167
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001368207Q00000X
CA20A5788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB29419OtherMEDICARE PTAN
WA7128952Medicaid
E60508Medicare UPIN