Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 0020063 | CO |
NPI | 1497208904 |
---|---|
Provider Name | Jarvis Ryals |
First Address | Pueblo, CO 81001-1048 |
Second Address | Pueblo, CO 81001-1048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2016 |
Last Update Date | 01/08/2016 |