Provider Demographics
NPI:1083818660
Name:RIDLEY, RYAN WINTRELL (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WINTRELL
Last Name:RIDLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:18100 HOUSTON METHODIST DR STE 220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3653
Mailing Address - Country:US
Mailing Address - Phone:832-783-1170
Mailing Address - Fax:281-333-0145
Practice Address - Street 1:18100 HOUSTON METHODIST DR STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3653
Practice Address - Country:US
Practice Address - Phone:832-783-1170
Practice Address - Fax:281-333-0145
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0026608207Y00000X
TXP3424207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB166198OtherMEDICARE - GROUP