Provider Demographics
NPI:1003033838
Name:AHERN, RYAN W (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:W
Last Name:AHERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 ROCK PRAIRIE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8652
Mailing Address - Country:US
Mailing Address - Phone:979-314-5400
Mailing Address - Fax:979-703-1040
Practice Address - Street 1:1651 ROCK PRAIRIE RD STE 103
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8652
Practice Address - Country:US
Practice Address - Phone:979-314-5400
Practice Address - Fax:979-703-1040
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6002207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX546357YME1Medicare PIN
TX8J6771Medicare PIN
TX8J6771Medicare PIN
TX8S2892OtherBCBS OF TEXAS INDIVIDUAL #