Organization
RYAN R. PINE, M.D. LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN R. PINE M.D. (OWNER)
(217) 348-0221
Entity
Organization
Contact information
Practice address
1605 REYNOLDS DR, CHARLESTON, IL 61920-3152
(217) 348-0221
(217) 345-1380
Mailing address
1605 REYNOLDS DR, CHARLESTON, IL 61920-3152
(217) 348-0221
(217) 345-1380
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPLIED FOR
—
IL
Enumeration date
10/23/2012
Last updated
12/13/2012
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