Individual
GERALDINE A. RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9426 PHOENIX VILLAGE PKWY, O FALLON, MO 63368-4781
(636) 561-5999
(636) 561-4746
Mailing address
9426 PHOENIX VILLAGE PKWY, O FALLON, MO 63368-4781
(636) 561-5999
(636) 561-4746
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
100756
MO
208000000X
Pediatrics Physician
100756
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110211326
RAILROAD MEDICARE
MO
Enumeration date
02/28/2006
Last updated
04/02/2015
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