Provider Demographics
NPI:1679756019
Name:ISOM, RYAN FRANKLIN (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:FRANKLIN
Last Name:ISOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 300 W STE 500
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3312
Mailing Address - Country:US
Mailing Address - Phone:801-357-7704
Mailing Address - Fax:801-357-7424
Practice Address - Street 1:1055 N 300 W STE 500
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3312
Practice Address - Country:US
Practice Address - Phone:801-357-7704
Practice Address - Fax:801-357-7424
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86158471205207W00000X, 207WX0107X
FLME109701207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology