Healthcare Provider Details

I. General information

NPI: 1316330640
Provider Name (Legal Business Name): RYAN ENDERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OSPREY BLVD STE 205
BARTOW FL
33830-4347
US

IV. Provider business mailing address

2000 OSPREY BLVD STE 205
BARTOW FL
33830-4347
US

V. Phone/Fax

Practice location:
  • Phone: 727-461-8231
  • Fax: 727-298-6637
Mailing address:
  • Phone: 727-461-8231
  • Fax: 727-298-6637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS18891
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOT017126
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number325978
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAP2282058A35
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: