Provider Demographics
NPI:1568463891
Name:THAI, RYAN T (MD)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:T
Last Name:THAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THU
Other - Middle Name:T
Other - Last Name:THAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3918 LEELAND ST
Mailing Address - Street 2:
Mailing Address - City:HOU
Mailing Address - State:TX
Mailing Address - Zip Code:77003-5648
Mailing Address - Country:US
Mailing Address - Phone:713-528-3400
Mailing Address - Fax:713-528-3377
Practice Address - Street 1:3918 LEELAND ST.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-5648
Practice Address - Country:US
Practice Address - Phone:713-528-3400
Practice Address - Fax:713-528-3377
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2014-06-24
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
TXL0947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL0947OtherSTATE LICENSE
TX151739301Medicaid
TX151738501Medicaid
TXTXB125433Medicare PIN
TX8278B6Medicare ID - Type UnspecifiedPROVIDER NUMBER
TX151738501Medicaid