Healthcare Provider Details

I. General information

NPI: 1730447848
Provider Name (Legal Business Name): RYAN JOSEPH BRANDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

PO BOX 750243
DAYTON OH
45475-0243
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-5642
  • Fax:
Mailing address:
  • Phone: 937-709-5051
  • Fax: 937-709-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number042.0013881
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number18354
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberRT-2441
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.144688
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number35.144688
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: