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General NPI Number Information
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NPI Number | 1003299413
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Entity Type | Individual
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Provider Name | RYAN BRADLEY SONDERGARD D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 2458 OLD DORSETT RD STE 110
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-2423
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Country | US
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Telephone | 636-939-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 N SCOTTSDALE RD STE 2500
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-7630
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Country | US
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Telephone | 216-468-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2016044657
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License Number State | MO
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