Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 34-008006 | OH |
NPI | 1063452704 |
---|---|
Provider Name | Jon P Ryan |
First Address | Dayton, OH 45415-1180 |
Second Address | Dayton, OH 45415-1180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2603605 | (05) | OH |
I28345 | (02) |