MEDICARE: DR. RYAN ALLEN DO

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
1	207Q00000X	Family Medicine Physician	20A6685	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020A66850	OTHER	CA	BLUE SHIELD OF CALIFORNIA
2	G09530	OTHER		TRI-CARE
3	20A6685	OTHER	CA	BLUE CROSS

General Provider Information

NPI Number	:	1265417752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN ALLEN DO

Provider Business Mailing Address
First Line	:	2342 PROFESSIONAL PKWY
Second Line	:	SUITE 260
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-1629
Country	:	US
Telephone Number	:	805-348-3910
Fax Number	:	805-348-3901

Provider Business Practice Location Address
First Line	:	2342 PROFESSIONAL PKWY
Second Line	:	SUITE 260
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-1629
Country	:	US
Telephone Number	:	805-348-3910
Fax Number	:	805-348-3901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	01/30/2015

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Directions to “ DR. RYAN ALLEN DO” Practice Location

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