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NPI Code Detail

MEDICARE: RYAN BRADLEY SONDERGARD D.O.

MEDICARE: RYAN BRADLEY SONDERGARD D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician2016044657MO

General Provider Information

NPI Number : 1003299413
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN BRADLEY SONDERGARD D.O.
Provider Business Mailing Address
First Line : 4800 N SCOTTSDALE RD STE 2500
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85251-7630
Country : US
Telephone Number : 216-468-5000
Fax Number :
Provider Business Practice Location Address
First Line : 2458 OLD DORSETT RD STE 110
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-2423
Country : US
Telephone Number : 636-939-2550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2015
Last Update Date : 05/28/2025

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