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General NPI Number Information
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NPI Number | 1659511202
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Entity Type | Individual
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Provider Name | RYAN MAXWELL DO
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Gender | Male
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2400 N ROCKTON AVE
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City | ROCKFORD
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State | IL
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Zip | 61103-3655
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Country | US
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Telephone | 815-971-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 101 OXFORD RD
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City | LANSDALE
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State | PA
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Zip | 19446-4763
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Country | US
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Telephone | 215-527-0571
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | OS015922
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 288918
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036.144123
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License Number State | IL
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