Wilson, Ryan M

Wilson, Ryan M is an sole proprietor health care provider with primary practice located at 1350 Hickory St , Melbourne FL 32901-3224. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Wilson, Ryan M can be contacted via phone (321) 434-1401.

Contact Information

Primary practice address
1350 Hickory St Melbourne FL 32901-3224
Phone: (321) 434-1401
Fax: (321) 434-1667
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X P9102044 Florida
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA9102044 Florida

Profile Details

NPI number 1306811567
LBN Legal business name Wilson, Ryan M
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 21st, 2006
Last updated Dec 1st, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306811567 NPPES
Florida Other E8442U FL MEDICARE
Florida Other P00466915 FL MEDICARE
Florida MEDICAID 291346100 FL MEDICARE

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