MEDICARE: RYAN MICHAEL MCCORMACK MD, PHD

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	207T00000X	Neurological Surgery Physician	V6061	TX

General Provider Information

NPI Number	:	1962922146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MICHAEL MCCORMACK MD, PHD

Provider Business Mailing Address
First Line	:	920 FROSTWOOD DR STE 2.300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2314
Country	:	US
Telephone Number	:	713-338-5519
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 GESSNER RD STE 560
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2572
Country	:	US
Telephone Number	:	713-984-6406
Fax Number	:

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

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	04/29/2025

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