MEDICARE: RYAN ALLEN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	11017957A	IN
2	207Q00000X	Family Medicine Physician	12503209-1204	UT

General Provider Information

NPI Number	:	1689089666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN ALLEN DO

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 E 1400 N
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84341-2406
Country	:	US
Telephone Number	:	435-716-4900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2014
Last Update Date	:	03/23/2026

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Directions to “ RYAN ALLEN DO” Practice Location

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