Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 32505 | OK |
NPI | 1396004057 |
---|---|
Provider Name | Dr. Ryan M Coughlan |
First Address | Austin, TX 78754-5705 |
Second Address | Round Rock, TX 78681-8025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2012 |
Last Update Date | 08/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200661280A | (05) | OK |
527532YNAV | (02) | OK |