Provider Demographics
NPI:1861920951
Name:KING, RYAN WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WILLIAM
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:169 ASHLEY AVE RM 202
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8900
Mailing Address - Country:US
Mailing Address - Phone:843-792-3504
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE L104
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-8900
Practice Address - Country:US
Practice Address - Phone:859-257-3253
Practice Address - Fax:859-323-1203
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL409202086S0129X
KY567742086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery