MEDICARE: RYAN JOHN ANDERSON PA-C

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	363AM0700X	Medical Physician Assistant	PA9118182	FL

General Provider Information

NPI Number	:	1356765366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN JOHN ANDERSON PA-C

Provider Business Mailing Address
First Line	:	1720 S ORANGE AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-2932
Country	:	US
Telephone Number	:	321-842-9000
Fax Number	:	321-842-9368

Provider Business Practice Location Address
First Line	:	1720 S ORANGE AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-2945
Country	:	US
Telephone Number	:	321-842-9000
Fax Number	:	321-842-9368

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

Provider Enumeration Date	:	02/11/2014
Last Update Date	:	12/06/2023

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Directions to “ RYAN JOHN ANDERSON PA-C” Practice Location

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