Provider Demographics
NPI:1588608194
Name:RYAN, LANGSTON RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LANGSTON
Middle Name:RAY
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6100 HARRIS PKWY
Mailing Address - Street 2:#245
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4131
Mailing Address - Country:US
Mailing Address - Phone:817-346-5336
Mailing Address - Fax:817-346-5366
Practice Address - Street 1:6100 HARRIS PKWY
Practice Address - Street 2:#245
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4131
Practice Address - Country:US
Practice Address - Phone:817-346-5336
Practice Address - Fax:817-346-5366
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF4465207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160046054OtherMEDICARE RAILROAD
TX129173404Medicaid
TX4373198OtherAETNA HMO
TX82952XOtherBC/BS
TX82952XOtherBC/BS
TX129173404Medicaid