Healthcare Provider Details

I. General information

NPI: 1659328391
Provider Name (Legal Business Name): SARAH A. RYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SARAH A. RUEFF

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 WELLNESS WAY STE 200
LAS VEGAS NV
89106-4142
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-0814
  • Fax: 702-877-0113
Mailing address:
  • Phone: 702-877-0814
  • Fax: 702-877-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number127435
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number127435
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number15436
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number15436
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: