Provider Demographics
NPI:1932498342
Name:STORK, RYAN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PATRICK
Last Name:STORK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1133 JOHN FREEMAN BLVD # 285A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2809
Mailing Address - Country:US
Mailing Address - Phone:713-486-2283
Mailing Address - Fax:
Practice Address - Street 1:1333 MOURSUND ST STE 129
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3405
Practice Address - Country:US
Practice Address - Phone:713-797-5929
Practice Address - Fax:713-797-5213
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301098293208100000X
TXS55072081P0301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation