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General NPI Number Information
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NPI Number | 1518303403
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Entity Type | Individual
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Provider Name | JAMES MATTHEW RYAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2013
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 1301 S CRISMON RD
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City | MESA
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State | AZ
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Zip | 85209-3767
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Country | US
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Telephone | 623-308-2472
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Fax |
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Provider Business Mailing Address
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Address Line | 2036 N GILBERT RD # 2-134 MC 9116A
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City | MESA
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State | AZ
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Zip | 85203-2139
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A156356
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License Number State | CA
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