Provider Demographics
NPI:1215297544
Name:PARR, RYAN MICHAEL
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:PARR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:MICHAEL
Other - Last Name:PARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ST
Mailing Address - Street 1:2023 SW 120TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1204
Mailing Address - Country:US
Mailing Address - Phone:352-316-6122
Mailing Address - Fax:
Practice Address - Street 1:2023 SW 120TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1204
Practice Address - Country:US
Practice Address - Phone:352-316-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist