Individual
DR. GORDON A RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1010 MURRAY AVE, SAN LUIS OBISPO, CA 93405
(805) 439-2998
(805) 439-2997
Mailing address
1023 NIPOMO ST STE 110, SAN LUIS OBISPO, CA 93401-6155
(805) 439-2998
(805) 439-2997
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101034688
VA
207R00000X
Internal Medicine Physician
C145619
CA
208M00000X
Hospitalist Physician
0101034688
VA
208M00000X
Hospitalist Physician
Primary
C145619
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005878900
—
VA
01
—
12085
SENTARA HEALTH PLANS
VA
Enumeration date
11/06/2006
Last updated
07/19/2018
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