Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 0910 | NV |
N | 213ES0103X | Foot & Ankle Surgery | 293 | NM |
NPI | 1083723274 |
---|---|
Provider Name | Dr. Ryan W Tingle |
First Address | Las Vegas, NV 89123-2839 |
Second Address | Las Vegas, NV 89102-2149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 30/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1083723274 | (05) | NV |
61224359 | (05) | NM |
CV152Z | (02) | NV |
P00857367 | RAILROAD MEDICARE (01) | NV |
U96219 | (02) | NM |