Healthcare Provider Details

I. General information

NPI: 1073924676
Provider Name (Legal Business Name): RYAN SHINGLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WESTGATE PKWY
DOTHAN AL
36303-2151
US

IV. Provider business mailing address

PO BOX 1928
DOTHAN AL
36302-1928
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-9595
  • Fax: 334-793-6984
Mailing address:
  • Phone: 334-793-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2837
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: