Healthcare Provider Details

I. General information

NPI: 1104888916
Provider Name (Legal Business Name): MICHAEL E RYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 N LIDGERWOOD ST STE 118
SPOKANE WA
99208-1122
US

IV. Provider business mailing address

5901 N LIDGERWOOD ST STE 118
SPOKANE WA
99208-1122
US

V. Phone/Fax

Practice location:
  • Phone: 509-483-2828
  • Fax: 509-484-7882
Mailing address:
  • Phone: 509-483-2828
  • Fax: 509-484-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD00019784
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: