Provider Demographics
NPI:1386054757
Name:CUDAHY, RYAN P (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:P
Last Name:CUDAHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN: CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2250 HAYES ST STE 302
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117
Practice Address - Country:US
Practice Address - Phone:415-379-2900
Practice Address - Fax:415-666-3144
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2018-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA157945207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine