MEDICARE: DR. RYAN B GOLUB D.P.M.

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	213E00000X	Podiatrist	0581	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0194890	OTHER	AZ	BCBS
2	2Z0183	OTHER	AZ	HEALTH NET

General Provider Information

NPI Number	:	1285635888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN B GOLUB D.P.M.

Provider Business Mailing Address
First Line	:	11209 N TATUM BLVD STE B100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3091
Country	:	US
Telephone Number	:	602-973-3888
Fax Number	:	602-973-3028

Provider Business Practice Location Address
First Line	:	11209 N TATUM BLVD STE B100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3091
Country	:	US
Telephone Number	:	602-973-3888
Fax Number	:	602-973-3028

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	03/26/2019

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