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General NPI Number Information
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NPI Number | 1508800145
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Entity Type | Individual
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Provider Name | JIMMY LYNN RYAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 1288 W 12700 S
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City | RIVERTON
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State | UT
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Zip | 84065-6794
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Country | US
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Telephone | 801-253-3500
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Fax | 801-253-5859
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Provider Business Mailing Address
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Address Line | PO BOX 1010
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City | RIVERTON
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State | UT
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Zip | 84065-1010
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Country | US
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Telephone | 801-253-3500
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Fax | 801-253-5859
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 172229-1205
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License Number State | UT
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