MEDICARE: KENNETH J RYAN MD

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	207ZM0300X	Medical Microbiology Physician	7742	AZ

Other Identifiers

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

General Provider Information

NPI Number	:	1790855153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH J RYAN MD

Provider Business Mailing Address
First Line	:	575 E RIVER RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5822
Country	:	US
Telephone Number	:	520-874-7400
Fax Number	:	520-874-3425

Provider Business Practice Location Address
First Line	:	1501 N CAMPBELL AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-0001
Country	:	US
Telephone Number	:	520-694-8888
Fax Number	:	520-626-6081

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	04/19/2026

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