Provider Demographics
NPI:1174811442
Name:KITTERMAN, RYAN TAYLOR (DPM)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:TAYLOR
Last Name:KITTERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 VETERANS DR UNIT 112
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35769-3716
Mailing Address - Country:US
Mailing Address - Phone:256-572-7389
Mailing Address - Fax:
Practice Address - Street 1:1601 VETERANS DR UNIT 112
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35769-3716
Practice Address - Country:US
Practice Address - Phone:801-889-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9029034-0501213ES0103X
AL403213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery