=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558312009
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY E RYAN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 09/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 N MURRAY HILL RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43228-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-878-7407
-----------------------------------------------------
Fax | 614-878-7447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 N MURRAY HILL RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43228-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-878-7407
-----------------------------------------------------
Fax | 614-878-7447
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 34-00-4034
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------