Basic Information
| Provider Information | |||||||||
| NPI: | 1124286968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURCH | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5100 W BROAD ST | ||||||||
| Address2: | DOCTORS HOSPITAL | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145442089 | ||||||||
| FaxNumber: | 6145441751 | ||||||||
| Practice Location | |||||||||
| Address1: | 5100 W BROAD ST | ||||||||
| Address2: | DOCTORS HOSPITAL | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145442089 | ||||||||
| FaxNumber: | 6145441751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 05/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 2015040165 | MO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.