Individual
MR. MICHAEL J RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1428 PHILLIPS LN STE 203, SAN LUIS OBISPO, CA 93401-2551
(805) 543-4407
(805) 543-4587
Mailing address
1428 PHILLIPS LN STE 203, SAN LUIS OBISPO, CA 93401-2551
(805) 543-4407
(805) 543-4587
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A86911
CA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
A86911
CA
207RP1001X
Pulmonary Disease Physician
Primary
A86911
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-029
TRICARE/CHAMPUS
VA
01
—
08329
NC BC/BS
NC
01
—
10025471
SENTARA/OPTIMA
VA
05
—
1700863511
—
VA
01
—
2174181
UHC/MAMSI
VA
01
—
342182
ANTHEM
VA
05
—
5908329
—
NC
01
—
6125139
CIGNA
VA
01
—
7221858
AETNA PIN
CA
01
—
7221858
AETNA
VA
01
—
PAR
MULTIPLAN
VA
05
—
WA86911A
—
CA
Enumeration date
12/22/2005
Last updated
11/03/2023
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