Basic Information
| Provider Information | |||||||||
| NPI: | 1043201015 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9722340813 | ||||||||
| Practice Location | |||||||||
| Address1: | 9200 PINECROFT DR STE 450 | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773803280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812960365 | ||||||||
| FaxNumber: | 2812988907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 01/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 205016 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RX0202X | 205016 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RX0202X | MD441313 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RX0202X | Q0553 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 205016 | 01 | MA | TUFTS HEALTH PLAN | OTHER | J22110 | 01 | MA | BCBS MA | OTHER | P01520676 | 01 | TX | RAILROAD MEDICARE | OTHER | 0100510 | 05 | MA | MEDICAID |