Provider Demographics
NPI:1780764258
Name:RYAN, ROBERT THOMAS III (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:THOMAS
Last Name:RYAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 E COURT STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5141
Mailing Address - Country:US
Mailing Address - Phone:830-379-8491
Mailing Address - Fax:830-386-0395
Practice Address - Street 1:1339 E COURT STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5141
Practice Address - Country:US
Practice Address - Phone:830-379-8491
Practice Address - Fax:830-386-0395
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8933208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CR085OtherBCBS
TX8P2311OtherBLUE CROSS BLUE SHIELD
TXP00141950OtherRAIL ROAD MEDICARE
TX169110701Medicaid
TX169110702Medicaid
0609670001Medicare NSC
TXB117966Medicare PIN
TX8CR085OtherBCBS
TX8C8151Medicare ID - Type Unspecified