Individual
RYAN AVERY BIRLEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-9729
(417) 820-6471
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 820-2000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2013017423
MO
2085R0204X
Vascular & Interventional Radiology Physician
2013017423
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598963761
—
MO
Enumeration date
07/10/2007
Last updated
03/29/2022
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