Provider Demographics
NPI:1154059640
Name:HALL, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:HALL
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 1:3098 HALF MOON AVE NW
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-9320
Mailing Address - Country:US
Mailing Address - Phone:319-430-5560
Mailing Address - Fax:
Practice Address - Street 1:3098 HALF MOON AVE NW
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:IA
Practice Address - Zip Code:52340-9320
Practice Address - Country:US
Practice Address - Phone:319-430-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist