Healthcare Provider Details

I. General information

NPI: 1093202129
Provider Name (Legal Business Name): RYAN MICHAEL GLYNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2018
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

PO BOX 741515
LOS ANGELES CA
90074-1515
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-7525
  • Fax: 206-625-7240
Mailing address:
  • Phone: 206-223-7525
  • Fax: 206-625-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD70119207
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: