Provider Demographics
NPI:1093802985
Name:MAGGART, JAMES RYAN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RYAN
Last Name:MAGGART
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 1:9200 PINECROFT DR
Mailing Address - Street 2:STE 255
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3279
Mailing Address - Country:US
Mailing Address - Phone:281-419-8400
Mailing Address - Fax:281-292-1972
Practice Address - Street 1:9200 PINECROFT DR
Practice Address - Street 2:STE 255
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3279
Practice Address - Country:US
Practice Address - Phone:281-419-8400
Practice Address - Fax:281-292-1972
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8423208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166153001Medicaid
TX166153001Medicaid
I02450Medicare UPIN