Provider Demographics
NPI:1144311507
Name:WALTER, RYAN K (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:K
Last Name:WALTER
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 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1924
Mailing Address - Country:US
Mailing Address - Phone:254-215-9704
Mailing Address - Fax:
Practice Address - Street 1:2700 E 29TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2531
Practice Address - Country:US
Practice Address - Phone:979-776-0371
Practice Address - Fax:979-776-0495
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3828207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184367401Medicaid
TX8F4447Medicare PIN
I69297Medicare UPIN