Healthcare Provider Details

I. General information

NPI: 1457559510
Provider Name (Legal Business Name): RYAN R ROWBERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W 18TH ST
SIOUX FALLS SD
57105-0401
US

IV. Provider business mailing address

PO BOX 820
SIOUX FALLS SD
57101-0820
US

V. Phone/Fax

Practice location:
  • Phone: 605-333-1000
  • Fax: 712-478-4086
Mailing address:
  • Phone: 605-940-7583
  • Fax: 712-478-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number7987
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number7987
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: