Provider Demographics
NPI:1710313135
Name:WOHLRABE, RYAN MARK (PA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MARK
Last Name:WOHLRABE
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4511 HORIZON HILL BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2449
Mailing Address - Country:US
Mailing Address - Phone:210-477-2626
Mailing Address - Fax:210-477-2650
Practice Address - Street 1:4511 HORIZON HILL BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2449
Practice Address - Country:US
Practice Address - Phone:210-477-2626
Practice Address - Fax:210-477-2650
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX530184YLJSMedicare PIN