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General NPI Number Information
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NPI Number | 1912232422
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Entity Type | Individual
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Provider Name | ALEXANDER RYAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 3050 MONTVALE DR STE A
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City | SPRINGFIELD
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State | IL
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Zip | 62704-6924
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Country | US
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Telephone | 217-726-8096
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Fax |
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Provider Business Mailing Address
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Address Line | 2040 W ILES AVE STE C
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4183
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Country | US
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Telephone | 217-789-0668
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MT190595
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME176276
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2013005692
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036-131849
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License Number State | IL
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