Provider Information for 1023308913
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RYAN LAVERDIERE
Sex: Male
NPI: 1023308913
Last Updated: 2021-07-01
Certification Date: 2021-07-01
Certification Date: 2021-07-01
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1023308913 | ||||||||||||
| Enumeration Date | 2011-04-12 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3032 NE 37TH PL OCALA, FL 34479-2198 United States Phone: 719-588-8154 | Fax: | ||||||||||||
| Primary Practice Address | 3032 NE 37TH PL OCALA, FL 34479-2198 United States Phone: 719-588-8154 | Fax: | ||||||||||||
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