Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 205016 | MA |
N | 111NI0900X | Internist | 205016 | MA |
N | 207RX0202X | Medical Oncology | 205016 | MA |
N | 207RX0202X | Medical Oncology | MD441313 | PA |
Y | 207RX0202X | Medical Oncology | Q0553 | TX |
NPI | 1043201015 |
---|---|
Provider Name | Dr. Paula D. Ryan |
First Address | Dallas, TX 75391-1230 |
Second Address | Shenandoah, TX 77380-3280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 28/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0100510 | (05) | MA |
205016 | TUFTS HEALTH PLAN (01) | MA |
G53123 | (02) | |
J22110 | BCBS MA (01) | MA |
P01520676 | RAILROAD MEDICARE (01) | TX |