Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 23850 | OK |
NPI | 1003951500 |
---|---|
Provider Name | Matthew Michael Ryan |
First Address | Oklahoma City, OK 73106 |
Second Address | Oklahoma City, OK 73106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 10/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200176990A | (05) | OK |