Healthcare Provider Details

I. General information

NPI: 1770555393
Provider Name (Legal Business Name): PAUL MCCAFFERTY RYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 MICA DR
CARSON CITY NV
89705-7268
US

IV. Provider business mailing address

PO BOX 1143
ZEPHYR COVE NV
89448-1143
US

V. Phone/Fax

Practice location:
  • Phone: 775-783-3082
  • Fax:
Mailing address:
  • Phone: 530-543-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number21229
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberC172740
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC172740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: