=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962814640
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYAN BARRY CHAPMAN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2014
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1250 GRUMMAN PL STE B
-----------------------------------------------------
City | TITUSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32780-7927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-269-4240
-----------------------------------------------------
Fax | 321-269-5428
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1250 GRUMMAN PL STE B
-----------------------------------------------------
City | TITUSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32780-7927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-269-4240
-----------------------------------------------------
Fax | 321-269-5428
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | OS15414
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------