Individual
KEITH T RYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
107 E OAK AVE, SUITE 202, FLAGSTAFF, AZ 86001-1818
(928) 213-8633
(928) 213-8634
Mailing address
107 E OAK AVE, SUITE 202, FLAGSTAFF, AZ 86001-1818
(928) 213-8633
(928) 213-8634
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22530
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167339
—
AZ
Enumeration date
02/14/2006
Last updated
03/01/2011
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