Basic Information
Provider Information
NPI: 1538622253
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHMOLL
FirstName: RYAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2270 W FLORAL CLIFF WAY
Address2:  
City: TUCSON
State: AZ
PostalCode: 857413886
CountryCode: US
TelephoneNumber: 5759214428
FaxNumber:  
Practice Location
Address1: 1501 N CAMPBELL AVE RM 4401
Address2:  
City: TUCSON
State: AZ
PostalCode: 857240001
CountryCode: US
TelephoneNumber: 5206267221
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/09/2019
LastUpdateDate: 05/27/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/27/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XR77244AZY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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