Provider Demographics
NPI:1881849883
Name:SHOOK, RYAN SETH (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SETH
Last Name:SHOOK
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 1:7900 N STADIUM DR APT 93
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4417
Mailing Address - Country:US
Mailing Address - Phone:361-658-4958
Mailing Address - Fax:
Practice Address - Street 1:7900 N STADIUM DR APT 93
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4417
Practice Address - Country:US
Practice Address - Phone:361-658-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L15500Medicare PIN