Individual
RYAN SOUTHWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1800 E. FLORENCE BLVD, CASA GRANDE, AZ 85122
(610) 776-4622
(610) 776-4622
Mailing address
1800 E FLORENCE BLVD, CASA GRANDE, AZ 85122-5303
(530) 902-3709
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
005891
AZ
Other
Enumeration date
06/27/2008
Last updated
02/13/2013
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