Healthcare Provider Details

I. General information

NPI: 1528742863
Provider Name (Legal Business Name): RYAN AVERY MADISON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 N SPRING ST STE A
HARRISON AR
72601-2913
US

IV. Provider business mailing address

PO BOX 2990
HARRISON AR
72602-2990
US

V. Phone/Fax

Practice location:
  • Phone: 870-365-0850
  • Fax: 870-365-0862
Mailing address:
  • Phone: 870-365-0850
  • Fax: 870-365-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-20704
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberE-20704
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: