Provider Demographics
NPI:1841449253
Name:RYAN N.BOURNE,MD.PA
Entity type:Organization
Organization Name:RYAN N.BOURNE,MD.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:NOLAND
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-646-6556
Mailing Address - Street 1:8715 VILLAGE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5405
Mailing Address - Country:US
Mailing Address - Phone:210-646-6556
Mailing Address - Fax:210-646-6330
Practice Address - Street 1:8715 VILLAGE DR STE 400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5407
Practice Address - Country:US
Practice Address - Phone:210-646-6656
Practice Address - Fax:210-646-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9875207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1578730271OtherNPI INDIVIDUAL
TX0A0037Medicare PIN