Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | OS10177 | FL |
NPI | 1073503843 |
---|---|
Provider Name | Dr. Walter Matthew Ryan III |
First Address | Miami, FL 33175-3584 |
Second Address | Plantation, FL 33324-1817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 21/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
279624400 | (05) | FL |
G82983 | (02) | FL |