Provider Demographics
NPI:1518588193
Name:JOHNSON, RYLEY (BSRT (R)(T))
Entity Type:Individual
Prefix:
First Name:RYLEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BSRT (R)(T)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2882 FARM ROAD 1499
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-0674
Mailing Address - Country:US
Mailing Address - Phone:903-332-1644
Mailing Address - Fax:
Practice Address - Street 1:3550 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5004
Practice Address - Country:US
Practice Address - Phone:903-785-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5090162085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology