Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 229854 | MA |
N | 111NI0900X | Internist | 229854 | MA |
N | 207RH0003X | Hematology & Oncology | 0101245298 | VA |
Y | 207RH0003X | Hematology & Oncology | 39335 | SC |
N | 207RH0003X | Hematology & Oncology | 44872 | TN |
NPI | 1073530432 |
---|---|
Provider Name | Perrie L Ryan |
First Address | West Columbia, SC 29171-6069 |
Second Address | West Columbia, SC 29169-4848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 11/11/2020 |