Healthcare Provider Details

I. General information

NPI: 1447731591
Provider Name (Legal Business Name): RYAN MEDINA OAKLEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10775 SW 56TH ST
MIAMI FL
33165-7043
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 Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO4074
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License NumberPO4074
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberPO4074
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO4074
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4074
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPO4074
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: