Individual
DR. RYAN GLENN MIYAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3620 JOSEPH SIEWICK DR STE 201, FAIRFAX, VA 22033-1758
(703) 391-0111
(703) 391-2945
Mailing address
1860 TOWN CENTER DR STE 300, RESTON, VA 20190-5900
(703) 435-6604
(703) 662-4506
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
0101245582
VA
Other
Enumeration date
02/14/2008
Last updated
01/12/2022
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