Healthcare Provider Details

I. General information

NPI: 1134937840
Provider Name (Legal Business Name): RYAN BUZZARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 MURDOCH AVE BLDG C
PARKERSBURG WV
26101-3230
US

IV. Provider business mailing address

1824 MURDOCH AVE BLDG C
PARKERSBURG WV
26101-3230
US

V. Phone/Fax

Practice location:
  • Phone: 304-916-1881
  • Fax:
Mailing address:
  • Phone: 304-916-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number23-921
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: