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Individual

RYAN STOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
405 W JACKSON ST, SIH MEDICAL GROUP ANESTHESIOLOGY, CARBONDALE, IL 62903-7646
(618) 457-5111
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 549-0721
(618) 529-0449

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036.136803
IL
207L00000X
Anesthesiology Physician
2011016799
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
214881
MULISPECIALTY GROUP PTAN
IL
Enumeration date
06/13/2011
Last updated
12/03/2020
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