Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 7189 | SD |
NPI | 1437311735 |
---|---|
Provider Name | Jon Ryckman |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Sioux Falls, SD 57105-1521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 20/08/2012 |