Individual
ANDREW RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1717 ARLINGTON AVE, EMERGENCY DEPARTMENT, CALDWELL, ID 83605-4802
(208) 459-4641
Mailing address
PO BOX 634646, CINCINNATI, OH 45263-0001
(800) 443-3672
(865) 560-7310
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-731
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA-731
LICENSE
ID
Enumeration date
02/27/2008
Last updated
02/27/2008
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