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General NPI Number Information
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NPI Number | 1841449253
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Entity Type | Organization
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Legal Business Name | RYAN N.BOURNE,MD.PA
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 8715 VILLAGE DR STE 400
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City | SAN ANTONIO
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State | TX
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Zip | 78217-5407
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Country | US
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Telephone | 210-646-6656
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Fax | 210-646-6330
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Provider Business Mailing Address
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Address Line | 8715 VILLAGE DR SUITE 400
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City | SAN ANTONIO
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State | TX
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Zip | 78217-5405
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Country | US
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Telephone | 210-646-6556
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Fax | 210-646-6330
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Authorized Official
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Title or Position | PRESIDENT
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Name | RYAN NOLAND BOURNE
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Credential | MD
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Telephone | 210-646-6556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M9875
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | M9875
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | M9875
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License Number State | TX
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