Provider Demographics
NPI:1952590754
Name:SHOCK, RYAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:SHOCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7200 WYOMING SPGS
Mailing Address - Street 2:STE 1150
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4303
Mailing Address - Country:US
Mailing Address - Phone:512-255-0125
Mailing Address - Fax:512-255-0153
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:STE 1150
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4303
Practice Address - Country:US
Practice Address - Phone:512-255-0125
Practice Address - Fax:512-255-0153
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1944213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX259179YS2ZMedicare UPIN