Healthcare Provider Details

I. General information

NPI: 1831169010
Provider Name (Legal Business Name): PAUL HAROLD RYAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 TARA HILLS DR SUITE D
PINOLE CA
94564-2530
US

IV. Provider business mailing address

1420 TARA HILLS DR SUITE D
PINOLE CA
94564-2530
US

V. Phone/Fax

Practice location:
  • Phone: 510-724-5222
  • Fax: 510-724-4714
Mailing address:
  • Phone: 510-724-5222
  • Fax: 510-724-4714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG416820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: