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NPI Code Detail

MEDICARE: DR. RYAN WILLIAM MCINTYRE MD

MEDICARE: DR. RYAN WILLIAM MCINTYRE MD
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
1207Q00000XFamily Medicine PhysicianA133029CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A133029OTHERCACALIFORNIA MEDICAL LICENSE

General Provider Information

NPI Number : 1164776555
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RYAN WILLIAM MCINTYRE MD
Provider Business Mailing Address
First Line : 1601 PRECISION PARK LN
Second Line :
City : SAN DIEGO
State : CA
Zip : 92173-1345
Country : US
Telephone Number : 619-662-4100
Fax Number :
Provider Business Practice Location Address
First Line : 4004 BEYER BLVD
Second Line :
City : SAN YSIDRO
State : CA
Zip : 92173-2099
Country : US
Telephone Number : 619-662-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2012
Last Update Date : 11/28/2022

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