Healthcare Provider Details

I. General information

NPI: 1003371410
Provider Name (Legal Business Name): RYAN TIMOTHY PYLES PA-C, MPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COMMERCE PARK DRIVE
RAPHINE VA
24472
US

IV. Provider business mailing address

2015 1ST ST
STAUNTON VA
24401-2923
US

V. Phone/Fax

Practice location:
  • Phone: 540-490-2527
  • Fax: 540-377-2099
Mailing address:
  • Phone: 540-280-0169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: