Individual
RYAN BOURDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
640 JACKSON ST, MC 11102F, SAINT PAUL, MN 55101-2502
(651) 254-3666
Mailing address
640 JACKSON ST, MC 11102F, SAINT PAUL, MN 55101-2502
(651) 254-3666
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
57524
MN
207P00000X
Emergency Medicine Physician
61856-20
WI
Other
Enumeration date
06/28/2011
Last updated
05/10/2019
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