Provider Demographics
NPI:1922238294
Name:KENNEDY, RYAN O (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:O
Last Name:KENNEDY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3701 JUNIUS ST
Mailing Address - Street 2:CS11 G006
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2026
Mailing Address - Country:US
Mailing Address - Phone:214-821-1599
Mailing Address - Fax:214-821-8985
Practice Address - Street 1:2710 SWISS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5900
Practice Address - Country:US
Practice Address - Phone:214-821-1599
Practice Address - Fax:214-821-8985
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2015-08-10
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Provider Licenses
StateLicense IDTaxonomies
TXQ47862086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery