Provider Demographics
NPI:1699902858
Name:KAGAN, RYAN MARK (DO)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MARK
Last Name:KAGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10905 MEMORIAL HERMANN DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3490
Mailing Address - Country:US
Mailing Address - Phone:713-436-9200
Mailing Address - Fax:713-436-9707
Practice Address - Street 1:10905 MEMORIAL HERMANN DR
Practice Address - Street 2:SUITE 109
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3490
Practice Address - Country:US
Practice Address - Phone:713-436-9200
Practice Address - Fax:713-436-9707
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2133208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics