Provider Demographics
NPI:1124286968
Name:BURCH, RYAN W (DO)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:W
Last Name:BURCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 W BROAD ST
Mailing Address - Street 2:DOCTORS HOSPITAL
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228
Mailing Address - Country:US
Mailing Address - Phone:614-544-2089
Mailing Address - Fax:614-544-1751
Practice Address - Street 1:5100 W BROAD ST
Practice Address - Street 2:DOCTORS HOSPITAL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228
Practice Address - Country:US
Practice Address - Phone:614-544-2089
Practice Address - Fax:614-544-1751
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2015040165207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program