MEDICARE: RYAN KIRK BINGHAM PA

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	6905	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14099384	OTHER	AZ	CAQH
2	6905	OTHER	AZ	PHYSICIAN ASSISTANT AZ STATE LICENSE

General Provider Information

NPI Number	:	1548779713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN KIRK BINGHAM PA

Provider Business Mailing Address
First Line	:	2855 E BROWN RD STE 28
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-4217
Country	:	US
Telephone Number	:	480-625-4538
Fax Number	:	480-625-4561

Provider Business Practice Location Address
First Line	:	2855 E BROWN RD STE 28
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-4217
Country	:	US
Telephone Number	:	480-625-4538
Fax Number	:	480-625-4561

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

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	09/08/2025

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