Healthcare Provider Details

I. General information

NPI: 1588050017
Provider Name (Legal Business Name): RYAN RIMMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOWARD AVE FL 4
NEW HAVEN CT
06519-1369
US

IV. Provider business mailing address

800 HOWARD AVE FL 4
NEW HAVEN CT
06519-1369
US

V. Phone/Fax

Practice location:
  • Phone: 877-985-3697
  • Fax:
Mailing address:
  • Phone:
  • Fax: 503-494-4631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD198371
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number68113
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: