Provider Demographics
NPI:1215065917
Name:BELLAW, RYAN S (PA-C)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:S
Last Name:BELLAW
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 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2338
Mailing Address - Country:US
Mailing Address - Phone:903-577-6000
Mailing Address - Fax:
Practice Address - Street 1:2320 HARTS BLUFF RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-7453
Practice Address - Country:US
Practice Address - Phone:903-577-9355
Practice Address - Fax:903-434-7039
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14528363A00000X
NC0010-00544363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant