Provider Demographics
NPI:1316094139
Name:TARANTOLA, RYAN M (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:TARANTOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2030
Mailing Address - Country:US
Mailing Address - Phone:850-476-6759
Mailing Address - Fax:850-484-5222
Practice Address - Street 1:5150 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2030
Practice Address - Country:US
Practice Address - Phone:850-476-6759
Practice Address - Fax:850-484-5222
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.127883207W00000X
MO2011011567207W00000X
FLME113112207W00000X, 207WX0107X
IA38326207W00000X
ALMD31780207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00726471Medicare PIN
IAI0923238Medicare PIN