Individual
MR. RYAN L FAGAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC LAT
Contact information
Practice address
7756 W. DELPHI PK., - 27, CONVERSE, IN 46919
(765) 384-4381
(765) 384-5414
Mailing address
312 E HARRISON ST, SWAYZEE, IN 46986-9570
(765) 922-7203
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000566A
IN
Other
Enumeration date
02/13/2006
Last updated
07/08/2007
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