Healthcare Provider Details

I. General information

NPI: 1053968149
Provider Name (Legal Business Name): RYAN MEDINA OAKLEY DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 NW 82ND AVE STE 320
DORAL FL
33166-7601
US

IV. Provider business mailing address

4131 SW 102ND CT
MIAMI FL
33165-4943
US

V. Phone/Fax

Practice location:
  • Phone: 305-930-7934
  • Fax: 305-203-4891
Mailing address:
  • Phone: 305-942-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN MEDINA OAKLEY
Title or Position: OWNER
Credential: DPM
Phone: 305-930-7934