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General NPI Number Information
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NPI Number | 1184287047
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Entity Type | Individual
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Provider Name | RYAN FILLER MD
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Gender | Male
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 862 MEINECKE AVE STE 100
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-3701
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Country | US
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Telephone | 805-541-4600
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Fax | 805-541-8716
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Provider Business Mailing Address
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Address Line | 1415 N DEARBORN ST APT 20C
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City | CHICAGO
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State | IL
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Zip | 60610-5534
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Country | US
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Telephone | 480-236-2446
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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 | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | 125.083145
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | A177196
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License Number State | CA
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