=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902127947
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYAN CARTER YOUNG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2010
-----------------------------------------------------
Last Update Date | 05/04/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 W 38TH ST STE 200
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78705-1167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-451-0103
-----------------------------------------------------
Fax | 512-451-2741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 W 38TH ST STE 200
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78705-1167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-451-0103
-----------------------------------------------------
Fax | 512-451-2741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | Q6384
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207WX0107X
-----------------------------------------------------
Taxonomy Name | Retina Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number | Q6384
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------