Provider Demographics
NPI:1316330640
Name:ENDERS, RYAN (DO)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:ENDERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 OSPREY BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-4347
Mailing Address - Country:US
Mailing Address - Phone:727-461-8231
Mailing Address - Fax:727-298-6637
Practice Address - Street 1:2000 OSPREY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4347
Practice Address - Country:US
Practice Address - Phone:727-461-8231
Practice Address - Fax:727-298-6637
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA325978208600000X
OHAP2282058A35207R00000X
PAOT017126208600000X
FLOS18891208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine