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NPI Code Detail

MEDICARE: CHARLES H RYAN PAC

MEDICARE: CHARLES H RYAN PAC
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
1363A00000XPhysician Assistant2699AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568479764
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES H RYAN PAC
Provider Business Mailing Address
First Line : 13803 E FIERY DAWN DR
Second Line :
City : VAIL
State : AZ
Zip : 85641-6457
Country : US
Telephone Number : 520-721-0997
Fax Number :
Provider Business Practice Location Address
First Line : 1270 W SILVERLAKE RD
Second Line :
City : TUCSON
State : AZ
Zip : 85713-2728
Country : US
Telephone Number : 520-547-8344
Fax Number : 520-351-8142
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 04/19/2012

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