Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | OS15825 | FL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 008511 | AZ |
NPI | 1053738229 |
---|---|
Provider Name | Ryan Anthony Neeley |
First Address | Gilbert, AZ 85234-1623 |
Second Address | Gilbert, AZ 85234-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2014 |
Last Update Date | 18/08/2020 |