Individual
RYAN J SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
333 E COUNTY LINE RD, SUITE B, GREENWOOD, IN 46143-1079
(317) 497-6333
(317) 497-6334
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01076036A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201168740
—
IN
01
—
P01724113
RR MEDICARE
IN
Enumeration date
05/20/2013
Last updated
11/27/2023
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