Healthcare Provider Details

I. General information

NPI: 1154416923
Provider Name (Legal Business Name): RYAN MENZIES TIERNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 JAMES CASEY ST SUTIE 100
AUSTIN TX
78745-3325
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 512-447-2202
  • Fax: 512-447-5337
Mailing address:
  • Phone: 972-997-8000
  • Fax: 972-234-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberBB4745785-2004014122
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberN3349
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: