MEDICARE: DR. RYAN KEITH COUVILLION M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician	R5253	TX

General Provider Information

NPI Number	:	1760706774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN KEITH COUVILLION M.D.

Provider Business Mailing Address
First Line	:	1900 SAINT JAMES PL STE 600
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-4136
Country	:	US
Telephone Number	:	713-850-0240
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 SAINT JAMES PL STE 600
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-4136
Country	:	US
Telephone Number	:	713-850-0240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2010
Last Update Date	:	09/05/2023

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