Provider Demographics
NPI:1386817039
Name:VALICEK, RYAN ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ALAN
Last Name:VALICEK
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 18103
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-8103
Mailing Address - Country:US
Mailing Address - Phone:281-980-1742
Mailing Address - Fax:281-980-1754
Practice Address - Street 1:7616 BRANFORD PL STE 320
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3794
Practice Address - Country:US
Practice Address - Phone:281-980-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005017763207R00000X
TXN7506207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty