Healthcare Provider Details

I. General information

NPI: 1780254326
Provider Name (Legal Business Name): RYAN ESSEX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9604 SW 18TH ST
OKLAHOMA CITY OK
73128-3020
US

IV. Provider business mailing address

9604 SW 18TH ST
OKLAHOMA CITY OK
73128-3020
US

V. Phone/Fax

Practice location:
  • Phone: 405-574-5801
  • Fax:
Mailing address:
  • Phone: 405-574-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number8069
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: