Provider Demographics
NPI:1427149178
Name:RICHARDS, RYAN A (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:RICHARDS
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 1:1055 N 500 W
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:1055 N 500 W STE 207
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3305
Practice Address - Country:US
Practice Address - Phone:801-375-4263
Practice Address - Fax:801-429-8085
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5924878-1205207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT245449OtherALTIUS
UT84628OtherPEHP
UT903371OtherDMBA
UT09-00576OtherUTAH HEALTHCARE
UTP00293576OtherPALMETTO
UT870281028RR2OtherEMIA
UT107040000101OtherIHC
UTD6299Medicaid
UT09-00576OtherUTAH HEALTHCARE
UT903371OtherDMBA
UT005502598Medicare ID - Type UnspecifiedMEICARE