Provider Demographics
NPI:1891973871
Name:TEAGUE, RYAN NEILAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:NEILAN
Last Name:TEAGUE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 GARNER FIELD RD. STE. 300
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801
Mailing Address - Country:US
Mailing Address - Phone:830-278-3086
Mailing Address - Fax:830-278-8873
Practice Address - Street 1:1195 GARNER FIELD RD. STE. 300
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801
Practice Address - Country:US
Practice Address - Phone:830-278-3086
Practice Address - Fax:830-278-8873
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05680363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K4970Medicare PIN
TX8K4969Medicare PIN
TX8K4967Medicare PIN