Provider Demographics
NPI:1588087506
Name:WHITEHORSE, RYAN JAY
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:JAY
Last Name:WHITEHORSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-7758
Mailing Address - Country:US
Mailing Address - Phone:405-310-9110
Mailing Address - Fax:
Practice Address - Street 1:1106 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7758
Practice Address - Country:US
Practice Address - Phone:405-310-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist