Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 036091276 | IL |
Y | 208600000X | Surgeon | 036091276 | IL |
NPI | 1013925718 |
---|---|
Provider Name | Dr. Raymond J Ryan JR. |
First Address | Greenville, IL 62246 |
Second Address | Greenville, IL 62246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 04/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G16025 | (02) | IL |