MEDICARE: SUSAN DIANE RYAN PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA04094	TX

General Provider Information

NPI Number	:	1003961152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DIANE RYAN PAC

Provider Business Mailing Address
First Line	:	850 CENTRAL PARKWAY E
Second Line	:	SUITE 275
City	:	PLANO
State	:	TX
Zip	:	75074
Country	:	US
Telephone Number	:	972-881-4688
Fax Number	:	972-881-4609

Provider Business Practice Location Address
First Line	:	850 CENTRAL PKWY E
Second Line	:	SUITE 275
City	:	PLANO
State	:	TX
Zip	:	75074-5561
Country	:	US
Telephone Number	:	972-881-4688
Fax Number	:	972-881-4609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/22/2014

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Directions to “ SUSAN DIANE RYAN PAC” Practice Location

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