Provider Demographics
NPI:1407885510
Name:RYAN, RONALD GARVIN (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:GARVIN
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7656 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8237
Mailing Address - Country:US
Mailing Address - Phone:407-996-4554
Mailing Address - Fax:704-863-9966
Practice Address - Street 1:7656 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8237
Practice Address - Country:US
Practice Address - Phone:407-996-4554
Practice Address - Fax:407-996-4064
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072151207Q00000X
NC2005-01320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905095Medicaid
NC5905095Medicaid
NC2059567Medicare ID - Type UnspecifiedCHUC PROSPERITY CROSSING
NC2059567AMedicare PIN