Healthcare Provider Details

I. General information

NPI: 1437503935
Provider Name (Legal Business Name): BENJAMIN RYBA-WHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SMITH AVE N STE 480
SAINT PAUL MN
55102-2377
US

IV. Provider business mailing address

345 SMITH AVE N
SAINT PAUL MN
55102-2346
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6258
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number65325
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number65325
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: