Individual
DR. JESSE THOMAS RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5100 W TAFT RD STE 3E, LIVERPOOL, NY 13088-3809
(315) 452-2350
(315) 452-2355
Mailing address
750 E ADAMS ST RM 241, SYRACUSE, NY 13210-2306
(315) 464-4636
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
0101240508
VA
207Y00000X
Otolaryngology Physician
12940
ND
207Y00000X
Otolaryngology Physician
Primary
279632-1
NY
207Y00000X
Otolaryngology Physician
4301104789
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18856
—
ND
Enumeration date
12/04/2006
Last updated
03/17/2018
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