Provider Demographics
NPI:1528266202
Name:MOORE, RYAN E (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:E
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6 WOODLAND RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9501
Mailing Address - Country:US
Mailing Address - Phone:707-968-0670
Mailing Address - Fax:707-968-9580
Practice Address - Street 1:6 WOODLAND RD STE 202
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574
Practice Address - Country:US
Practice Address - Phone:707-968-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126952207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery