Provider Demographics
NPI:1750574372
Name:TEICHELMAN, RYAN DANE (PA-C)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:DANE
Last Name:TEICHELMAN
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:P O BOX 52230
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159
Mailing Address - Country:US
Mailing Address - Phone:806-350-2663
Mailing Address - Fax:806-350-2664
Practice Address - Street 1:7000 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1709
Practice Address - Country:US
Practice Address - Phone:806-350-2663
Practice Address - Fax:806-350-2664
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05297363LF0000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U9290OtherBCBS
TX8U9290OtherBCBS