Provider Demographics
NPI:1053738229
Name:NEELEY, RYAN ANTHONY (DO)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ANTHONY
Last Name:NEELEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 N HIGLEY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-1623
Mailing Address - Country:US
Mailing Address - Phone:480-543-6700
Mailing Address - Fax:480-543-6725
Practice Address - Street 1:1920 N HIGLEY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1623
Practice Address - Country:US
Practice Address - Phone:480-543-6700
Practice Address - Fax:480-543-6725
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15825207X00000X
OH390200000X
AZ008511207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program