Provider Demographics
NPI:1679950976
Name:RYBURN, CULLEN DEAN (MD)
Entity type:Individual
Prefix:
First Name:CULLEN
Middle Name:DEAN
Last Name:RYBURN
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 1:3101 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3162
Mailing Address - Country:US
Mailing Address - Phone:605-371-7100
Mailing Address - Fax:605-371-7199
Practice Address - Street 1:1747 POLY DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-1728
Practice Address - Country:US
Practice Address - Phone:406-294-1994
Practice Address - Fax:605-371-7199
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT109488207W00000X
COTL.0005958390200000X
FLME139428207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program