Individual
DR. RYAN D. MATHERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2115 W LEXINGTON AVE, ELKHART, IN 46514-1423
(574) 296-3955
(574) 296-3999
Mailing address
PO BOX 2968, ELKHART, IN 46515-2968
(574) 296-3955
(574) 296-3999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01027540A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100112400A
—
IN
Enumeration date
05/27/2005
Last updated
10/19/2010
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