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General NPI Number Information
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NPI Number | 1689640609
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Entity Type | Individual
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Provider Name | GERALDINE A. RYAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 9426 PHOENIX VILLAGE PKWY
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City | O FALLON
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State | MO
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Zip | 63368-4781
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Country | US
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Telephone | 636-561-5999
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Fax | 636-561-4746
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Provider Business Mailing Address
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Address Line | 9426 PHOENIX VILLAGE PKWY
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City | O FALLON
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State | MO
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Zip | 63368-4781
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Country | US
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Telephone | 636-561-5999
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Fax | 636-561-4746
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 100756
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 100756
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License Number State | MO
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