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General NPI Number Information
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NPI Number | 1518588193
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Entity Type | Individual
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Provider Name | RYLEY JOHNSON BSRT (R)(T)
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Gender | Male
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 3550 NE LOOP 286
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City | PARIS
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State | TX
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Zip | 75460-5004
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Country | US
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Telephone | 903-785-0031
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Fax |
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Provider Business Mailing Address
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Address Line | 2882 FARM ROAD 1499
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City | PARIS
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State | TX
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Zip | 75460-0674
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Country | US
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Telephone | 903-332-1644
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 509016
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License Number State | TX
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