Individual
MR. RYAN DAVID NICKLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4881 SUGAR MAPLE DR, WPAFB, OH 45433-5529
(376) 302-1619
Mailing address
4881 SUGAR MAPLE DR, WPAFB, OH 45433-5529
(937) 630-2161
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
010050
GA
207L00000X
Anesthesiology Physician
Primary
35.149304
OH
207L00000X
Anesthesiology Physician
MD476020
PA
Other
Enumeration date
06/06/2018
Last updated
11/19/2024
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