Healthcare Provider Details

I. General information

NPI: 1417488214
Provider Name (Legal Business Name): RYAN BEAN BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 SW GATLIN BLVD
PORT ST LUCIE FL
34953-2777
US

IV. Provider business mailing address

1750 SW GATLIN BLVD
PORT ST LUCIE FL
34953-2777
US

V. Phone/Fax

Practice location:
  • Phone: 706-858-8832
  • Fax:
Mailing address:
  • Phone: 772-446-8028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License NumberAS5381
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: