Healthcare Provider Details

I. General information

NPI: 1356722698
Provider Name (Legal Business Name): RYAN WILLIAM ZIPPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 18TH ST STE 230
COLUMBUS IN
47201-5359
US

IV. Provider business mailing address

104 AMELIA CT
YORKTOWN VA
23693-4447
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-9261
  • Fax:
Mailing address:
  • Phone: 317-410-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2021-02824
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberLL38433
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01083970A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: