Basic Information
| Provider Information | |||||||||
| NPI: | 1184060808 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARGA | ||||||||
| FirstName: | RYAN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2680 | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859022680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285323926 | ||||||||
| FaxNumber: | 9285379634 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 E DEUCE OF CLUBS | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859014808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285323926 | ||||||||
| FaxNumber: | 9285379634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2013 | ||||||||
| LastUpdateDate: | 08/12/2016 | ||||||||
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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 | 207Q00000X | 006908 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 136734 | 05 | AZ | MEDICAID |