Provider Demographics
NPI:1962551101
Name:RYAN, GLORIA MARY (MD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:MARY
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SUNDANCE TRL
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-3924
Mailing Address - Country:US
Mailing Address - Phone:772-492-0908
Mailing Address - Fax:
Practice Address - Street 1:1900 27TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3383
Practice Address - Country:US
Practice Address - Phone:772-794-7461
Practice Address - Fax:772-794-7453
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7803ZMedicare ID - Type Unspecified