Healthcare Provider Details

I. General information

NPI: 1740381409
Provider Name (Legal Business Name): RYAN PATRICK PEIRSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 5TH ST BLDG 840
WRIGHT PAT OH
45433-7951
US

IV. Provider business mailing address

PO BOX 268
YELLOW SPRINGS OH
45387-0268
US

V. Phone/Fax

Practice location:
  • Phone: 937-938-2766
  • Fax:
Mailing address:
  • Phone: 937-319-1599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number35089777
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35089777
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: