Healthcare Provider Details

I. General information

NPI: 1558550004
Provider Name (Legal Business Name): RYAN ELIZABETH MATSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 EATON AVE
HAMILTON OH
45013-2767
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 513-867-2270
  • Fax: 513-867-2581
Mailing address:
  • Phone: 800-875-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50002677
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: