Healthcare Provider Details

I. General information

NPI: 1528064599
Provider Name (Legal Business Name): WILLIAM SCOTT RYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LIBERTY HILL RD
LUMBERTON NC
28358-2446
US

IV. Provider business mailing address

400 LIBERTY HILL RD
LUMBERTON NC
28358-2446
US

V. Phone/Fax

Practice location:
  • Phone: 910-739-3318
  • Fax: 910-671-3600
Mailing address:
  • Phone: 910-739-3318
  • Fax: 910-671-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number28895
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: