Individual
DR. RYAN MICHAEL NORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2600
(417) 820-2100
Mailing address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2008025169
MO
207RN0300X
Nephrology Physician
4250
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659574218
—
MO
05
—
189833003
—
AR
01
—
2008025169
STATE LICENSE
MO
01
—
4250
MEDICAL LICENSE
OK
01
—
431560263
TRICARE
MO
Enumeration date
06/08/2007
Last updated
12/10/2020
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