Provider Demographics
NPI:1427107978
Name:RYAN, STEPHEN CARME (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CARME
Last Name:RYAN
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 1:316 MARTIN LUTHER KING JR WAY STE 401
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4266
Mailing Address - Country:US
Mailing Address - Phone:253-403-6850
Mailing Address - Fax:
Practice Address - Street 1:316 MARTIN LUTHER KING JR WAY STE 401
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4266
Practice Address - Country:US
Practice Address - Phone:253-403-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047647207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8479065Medicaid
WAG8869723-PIERCE COMedicare PIN
WAG8865676-KING COMedicare PIN