Provider Demographics
NPI:1306353222
Name:HOBBY, RYAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:HOBBY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2991 LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457-9334
Mailing Address - Country:US
Mailing Address - Phone:231-670-7613
Mailing Address - Fax:
Practice Address - Street 1:1400 MERCY DR # 100
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1836
Practice Address - Country:US
Practice Address - Phone:231-733-1326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-30
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant