Healthcare Provider Details

I. General information

NPI: 1366457236
Provider Name (Legal Business Name): ALEXEY A RYSKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 JADWIN AVE
RICHLAND WA
99352-3437
US

IV. Provider business mailing address

P.O. BOX 1408
RICHLAND WA
99352-1408
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-3340
  • Fax: 509-943-7909
Mailing address:
  • Phone: 509-946-3340
  • Fax: 509-943-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number5566449-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD60323495
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD60323495
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: