Provider Demographics
NPI:1043201015
Name:RYAN, PAULA D (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:D
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:9200 PINECROFT DR STE 450
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3280
Practice Address - Country:US
Practice Address - Phone:281-296-0365
Practice Address - Fax:281-298-8907
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205016207R00000X, 207RX0202X
PAMD441313207RX0202X
TXQ0553207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA205016OtherTUFTS HEALTH PLAN
MAJ22110OtherBCBS MA
TXP01520676OtherRAILROAD MEDICARE
MA0100510Medicaid
TXP01520676OtherRAILROAD MEDICARE
TX341448401Medicare PIN
TX370921YKYCMedicare PIN
G53123Medicare UPIN