Provider Demographics
NPI:1659739399
Name:SMITH, RYAN CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CRAIG
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 SANTA FE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2290
Mailing Address - Country:US
Mailing Address - Phone:361-887-9600
Mailing Address - Fax:361-883-1661
Practice Address - Street 1:1315 SANTA FE ST STE 201
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2290
Practice Address - Country:US
Practice Address - Phone:361-887-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012425062084P0800X
TXR61042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty