Provider Demographics
NPI:1437470077
Name:RYAN, CAITRIONA (MB BCH BAO)
Entity Type:Individual
Prefix:DR
First Name:CAITRIONA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MB BCH BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 COLE AVE APT 341
Mailing Address - Street 2:3135
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1323
Mailing Address - Country:US
Mailing Address - Phone:469-321-6764
Mailing Address - Fax:
Practice Address - Street 1:3900 JUNIUS ST
Practice Address - Street 2:SUITE 145
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1615
Practice Address - Country:US
Practice Address - Phone:469-321-6764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8185207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology