Provider Demographics
NPI:1538810601
Name:HILL, RYAN JAMES
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3647 HIGHWAY 39
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603
Mailing Address - Country:US
Mailing Address - Phone:458-254-4465
Mailing Address - Fax:
Practice Address - Street 1:3647 HWY 39
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-9760
Practice Address - Country:US
Practice Address - Phone:458-254-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist