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Individual

KEITH RYAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 450-4209
Mailing address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 450-4209

Taxonomy

Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
2084N0400X
Neurology Physician
Primary
A162636
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
VAD0000
MILITARY PHYSICIAN
Enumeration date
06/12/2017
Last updated
09/27/2024
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