Healthcare Provider Details

I. General information

NPI: 1063452704
Provider Name (Legal Business Name): JON P RYAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N MAIN ST SUITE 200
DAYTON OH
45415-1180
US

IV. Provider business mailing address

9000 N MAIN ST SUITE 200
DAYTON OH
45415-1180
US

V. Phone/Fax

Practice location:
  • Phone: 937-836-5555
  • Fax: 937-836-7518
Mailing address:
  • Phone: 937-836-5555
  • Fax: 937-836-7518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number34-008006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: