Healthcare Provider Details

I. General information

NPI: 1245266584
Provider Name (Legal Business Name): RYAN J AHR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12709 TOEPPERWEIN RD STE 101
LIVE OAK TX
78233-3259
US

IV. Provider business mailing address

12709 TOEPPERWEIN RD STE 101
LIVE OAK TX
78233-3259
US

V. Phone/Fax

Practice location:
  • Phone: 210-625-4733
  • Fax:
Mailing address:
  • Phone: 210-625-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004908
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19329
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: