Healthcare Provider Details

I. General information

NPI: 1861243305
Provider Name (Legal Business Name): RYAN EVAN RESTREPO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-3229
  • Fax: 252-744-3877
Mailing address:
  • Phone: 252-744-2149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberREST-KEG0GB
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: