Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A83236 | CA |
N | 111NI0900X | Internist | A83236 | CA |
Y | 207RX0202X | Medical Oncology | 64731 | MN |
N | 207RX0202X | Medical Oncology | A83236 | CA |
NPI | 1083672000 |
---|---|
Provider Name | Dr. Charles J. Ryan |
First Address | San Francisco, CA 94143-0001 |
Second Address | Minneapolis, MN 55455-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 13/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0A8323600 | (05) | CA |
G92791 | (02) | CA |