Healthcare Provider Details

I. General information

NPI: 1407098023
Provider Name (Legal Business Name): RYAN KEITH BRISLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 CAMPBELL DR STE 201
IRONTON OH
45638-2301
US

IV. Provider business mailing address

305 N 5TH ST
IRONTON OH
45638-1578
US

V. Phone/Fax

Practice location:
  • Phone: 740-534-9195
  • Fax: 740-534-9327
Mailing address:
  • Phone: 740-532-3534
  • Fax: 740-532-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.096567
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: