Provider Demographics
NPI:1154416923
Name:TIERNEY, RYAN MENZIES (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MENZIES
Last Name:TIERNEY
Suffix:
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:4101 JAMES CASEY ST
Practice Address - Street 2:SUTIE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3325
Practice Address - Country:US
Practice Address - Phone:512-447-2202
Practice Address - Fax:512-447-5337
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOBB4745785-20040141222085R0001X
TXN33492085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203872101Medicaid
TX8CA670OtherBCBS
TXP00784606OtherRAILROAD MEDICARE
TX203872102Medicaid
TX203872102Medicaid
TX8L15449Medicare PIN