Provider Demographics
NPI:1528158060
Name:RYAN, JOSEPH C (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:607 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3409
Mailing Address - Country:US
Mailing Address - Phone:337-258-0804
Mailing Address - Fax:337-989-6798
Practice Address - Street 1:607 GREENBRIAR RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-0000
Practice Address - Country:US
Practice Address - Phone:337-258-0804
Practice Address - Fax:337-989-6798
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026064207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA05726Medicaid
LAH91471Medicare UPIN
LA4F350Medicare ID - Type Unspecified