Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 01085987A | IN |
N | 207PP0204X | Pediatric Emergency Physician | 01085987A | IN |
N | 208000000X | Pediatrician | R-11292 | IA |
NPI | 1427541143 |
---|---|
Provider Name | Ryan S Squires |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2018 |
Last Update Date | 12/07/2021 |