Individual
MR. RYAN WELLS PENROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
19841 N 27TH AVE STE 403, PHOENIX, AZ 85027-4007
(602) 439-0274
(480) 900-8625
Mailing address
19841 N 27TH AVE STE 403, PHOENIX, AZ 85027-4007
(602) 439-0274
(480) 900-8625
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5814
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
493484
—
AZ
Enumeration date
09/25/2014
Last updated
11/08/2024
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