Healthcare Provider Details

I. General information

NPI: 1538858287
Provider Name (Legal Business Name): RYAN J IMBER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 W THUNDERBIRD BLVD
SUN CITY AZ
85351-3004
US

IV. Provider business mailing address

10401 W THUNDERBIRD BLVD
SUN CITY AZ
85351-3004
US

V. Phone/Fax

Practice location:
  • Phone: 623-832-4728
  • Fax:
Mailing address:
  • Phone: 520-832-4728
  • Fax: 623-832-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number80287
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number80287
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: