Healthcare Provider Details

I. General information

NPI: 1265538946
Provider Name (Legal Business Name): DAVID T RYU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MCCREIGHT AVE SUITE 211
SPRINGFIELD OH
45504
US

IV. Provider business mailing address

PO BOX 2910
SPRINGFIELD OH
45501
US

V. Phone/Fax

Practice location:
  • Phone: 937-390-3277
  • Fax: 937-390-1330
Mailing address:
  • Phone: 937-390-3277
  • Fax: 937-390-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number050865
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: