Provider Demographics
NPI:1467680637
Name:ENLOE, ROBERT RYAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RYAN
Last Name:ENLOE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 E HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9596
Mailing Address - Fax:
Practice Address - Street 1:15801 W HWY 71 BLDG 1
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-2702
Practice Address - Country:US
Practice Address - Phone:512-676-2500
Practice Address - Fax:512-406-7377
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202674207R00000X, 208D00000X
TXR6775207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX385907601Medicaid
TX385907602Medicaid