Provider Demographics
NPI:1629042312
Name:ARMENTOR, RYAN PAUL
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PAUL
Last Name:ARMENTOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54422
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4422
Mailing Address - Country:US
Mailing Address - Phone:337-470-2195
Mailing Address - Fax:337-470-2019
Practice Address - Street 1:4801 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6917
Practice Address - Country:US
Practice Address - Phone:337-470-2195
Practice Address - Fax:337-470-4590
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200045363AS0400X
LAPA.200045.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1529893Medicaid
LA56833P806Medicare PIN
LAQ62018Medicare UPIN