Provider Demographics
NPI:1386873081
Name:HEAD, RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:HEAD
Suffix:
Gender:
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2714 N UNIVERSITY DR
Mailing Address - Street 2:STE 100
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2974
Mailing Address - Country:US
Mailing Address - Phone:936-305-5050
Mailing Address - Fax:903-305-5151
Practice Address - Street 1:625 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1247
Practice Address - Country:US
Practice Address - Phone:936-305-5050
Practice Address - Fax:963-305-5151
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS760-L208000000X
TXQ3007208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics