Individual
JASON W RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2080 W ARLINGTON BLVD STE B, GREENVILLE, NC 27834
(252) 752-2140
(252) 689-6502
Mailing address
2080 W ARLINGTON BLVD STE B, GREENVILLE, NC 27834-3770
(252) 752-2140
(252) 689-6502
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
200200591
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131P8
BCBS OF NC
NC
01
—
1396807988
TRICARE
NC
01
—
195403
MEDCOST
NC
05
—
89131P8
—
NC
01
—
P00603496
RAILROAD MEDICARE
NC
Enumeration date
12/14/2006
Last updated
04/08/2021
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