Provider Demographics
NPI:1184972002
Name:LAROQUE, RYAN DOUGLAS
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:DOUGLAS
Last Name:LAROQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 EXCHANGE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-2116
Mailing Address - Country:US
Mailing Address - Phone:817-480-8799
Mailing Address - Fax:
Practice Address - Street 1:524 EXCHANGE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-2116
Practice Address - Country:US
Practice Address - Phone:817-480-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2481246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic