Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | BP1-0026608 | TX |
NPI | 1083818660 |
---|---|
Provider Name | Dr. Ryan Wintrell Ridley |
First Address | Sugar Land, TX 77478-3842 |
Second Address | Sugar Land, TX 77479-2891 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 21/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TXB166198 | MEDICARE - GROUP (01) | TX |