Provider Demographics
NPI:1164963153
Name:VALLO, RYAN J (PA)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:J
Last Name:VALLO
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-514-3500
Mailing Address - Fax:314-878-7678
Practice Address - Street 1:5201 MID AMERICA PLZ
Practice Address - Street 2:DEPT ORTHOPAEDIC SURG, STE 1500
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-0002
Practice Address - Country:US
Practice Address - Phone:314-514-3500
Practice Address - Fax:314-878-7678
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2017007596363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant