MEDICARE: RYAN O'NEAL P.A.-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	363A00000X	Physician Assistant	0110002096	VA
2	363A00000X	Physician Assistant	1030	NE
3	363A00000X	Physician Assistant	PA.0004596	CO

General Provider Information

NPI Number	:	1750306007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN O'NEAL P.A.-C

Provider Business Mailing Address
First Line	:	2695 ROCKY MOUNTAIN AVE STE 150
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-9071
Country	:	US
Telephone Number	:	970-624-2417
Fax Number	:	970-652-2927

Provider Business Practice Location Address
First Line	:	2767 JANITELL RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4102
Country	:	US
Telephone Number	:	719-365-2888
Fax Number	:	719-365-1577

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	12/23/2022

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