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NPI Code Detail

MEDICARE: RYAN AVERY MADISON DO

MEDICARE: RYAN AVERY MADISON 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
1207Q00000XFamily Medicine PhysicianE-20704AR
2207VF0040XUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianE-20704AR

General Provider Information

NPI Number : 1528742863
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN AVERY MADISON DO
Provider Business Mailing Address
First Line : PO BOX 2990
Second Line :
City : HARRISON
State : AR
Zip : 72602-2990
Country : US
Telephone Number : 870-365-0850
Fax Number : 870-365-0862
Provider Business Practice Location Address
First Line : 724 N SPRING ST STE A
Second Line :
City : HARRISON
State : AR
Zip : 72601-2913
Country : US
Telephone Number : 870-365-0850
Fax Number : 870-365-0862
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2023
Last Update Date : 05/20/2026

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