=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265708648
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYAN LANDIS SLOAD MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2012
-----------------------------------------------------
Last Update Date | 01/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BLDG. H 2005 KNIGHT LANE NAVY MEDICINE SUPPORT COMMAND
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32212-0140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-682-0193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6000 W HIGHWAY 98
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32512-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-505-6456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 27440
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------