Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 0103301197 | VA |
NPI | 1043624372 |
---|---|
Provider Name | Dr. Ryan Vazales |
First Address | Glen Allen, VA 23059-2619 |
Second Address | Glen Allen, VA 23059-2619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2014 |
Last Update Date | 14/07/2021 |