Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 32427 | MO |
NPI | 1013908052 |
---|---|
Provider Name | Dr. David L Ryan |
First Address | Trenton, MO 64683-2238 |
Second Address | Trenton, MO 64683-2238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 08/07/2007 |