Provider Demographics
NPI:1083723274
Name:TINGLE, RYAN W (DPM)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:W
Last Name:TINGLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8655 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2839
Mailing Address - Country:US
Mailing Address - Phone:702-877-8625
Mailing Address - Fax:702-877-5243
Practice Address - Street 1:2316 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2149
Practice Address - Country:US
Practice Address - Phone:702-877-8625
Practice Address - Fax:702-877-5243
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM293213ES0103X
NV0910213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1083723274Medicaid
NVP00857367OtherRAILROAD MEDICARE
NM61224359Medicaid
NV1083723274Medicaid
NVP00857367OtherRAILROAD MEDICARE
NV0673440002Medicare NSC
NMU96219Medicare UPIN