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General NPI Number Information
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NPI Number | 1053656082
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Entity Type | Organization
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Legal Business Name | PAUL F.RYAN MD INC.
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 12/03/2012
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Provider Practice Location Address
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Address Line | 2131 ELKS DR SUITE 103
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-5544
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Country | US
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Telephone | 909-886-6891
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Fax | 909-886-9034
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Provider Business Mailing Address
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Address Line | 2131 ELKS DRIVE SUITE 103
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-5571
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Country | US
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Telephone | 909-886-6891
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Fax | 909-886-9034
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL FREDERIC RYAN
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Credential | MD
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Telephone | 909-886-6891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G31886
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License Number State | CA
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