Healthcare Provider Details

I. General information

NPI: 1346773082
Provider Name (Legal Business Name): RYAN ALEXANDER DO, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 BALL CAMP PIKE
KNOXVILLE TN
37921-3234
US

IV. Provider business mailing address

200 TECH CENTER DR
KNOXVILLE TN
37912-2747
US

V. Phone/Fax

Practice location:
  • Phone: 865-523-4704
  • Fax:
Mailing address:
  • Phone: 865-637-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3603
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number3603
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3603
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number3603
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: