Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 00201797 | CO |
Y | 204E00000X | Oral & Maxillofacial Surgeon | P3432 | TX |
NPI | 1245490531 |
---|---|
Provider Name | Robert Cory Ryan |
First Address | Austin, TX 78741-4500 |
Second Address | Austin, TX 78741-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 16/12/2015 |