Provider Demographics
NPI:1538268271
Name:MURTHA, RYAN PATRICK (PA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:MURTHA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-7380
Mailing Address - Fax:
Practice Address - Street 1:800 COOPER AVE STE 4
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5371
Practice Address - Country:US
Practice Address - Phone:989-583-7380
Practice Address - Fax:989-753-2198
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM74460304Medicare PIN