Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD2012-0220 | NM |
Y | 208600000X | Surgeon | MD2012-0220 | NM |
N | 208200000X | Surgeon | N6734 | TX |
N | 208600000X | Surgeon | N6734 | TX |
NPI | 1003092701 |
---|---|
Provider Name | Dr. Ryan P. Tyner |
First Address | Albuquerque, NM 87125-6028 |
Second Address | Albuquerque, NM 87114-5916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2008 |
Last Update Date | 16/03/2020 |