Basic Information
| Provider Information | |||||||||
| NPI: | 1679756019 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ISOM | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | FRANKLIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 N 300 W | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013577704 | ||||||||
| FaxNumber: | 8013577424 | ||||||||
| Practice Location | |||||||||
| Address1: | 1055 N 300 W | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013577704 | ||||||||
| FaxNumber: | 8013577424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2007 | ||||||||
| LastUpdateDate: | 09/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME109701 | FL | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 86158471205 | UT | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0107X | 86158471205 | UT | Y |
No ID Information.