Provider Demographics
NPI:1841271319
Name:RYAN, WILLIAM JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:RYAN
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 1:34910 INTERSTATE 10 W
Mailing Address - Street 2:SUITE 601
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9229
Mailing Address - Country:US
Mailing Address - Phone:830-248-1207
Mailing Address - Fax:830-331-1110
Practice Address - Street 1:34910 INTERSTATE 10 W
Practice Address - Street 2:SUITE 601
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9229
Practice Address - Country:US
Practice Address - Phone:830-248-1207
Practice Address - Fax:830-331-1110
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2431207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046830802Medicaid
TX046830802Medicaid
TX292472Medicare PIN