Provider Demographics
NPI:1124680624
Name:SUSAN M RYAN, DPM
Entity type:Organization
Organization Name:SUSAN M RYAN, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-680-2185
Mailing Address - Street 1:6000 FAIRWAY DR STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4245
Mailing Address - Country:US
Mailing Address - Phone:303-680-2185
Mailing Address - Fax:916-435-6372
Practice Address - Street 1:11795 EDUCATION ST STE 230
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2469
Practice Address - Country:US
Practice Address - Phone:530-368-0218
Practice Address - Fax:916-435-6372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty