Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | A44628 | CA |
NPI | 1093743239 |
---|---|
Provider Name | Dr. Robert Eldon Ryan III |
First Address | Ventura, CA 93003-1148 |
Second Address | Ventura, CA 93003-1148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 12/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E82971 | (02) | CA |