MEDICARE: RYAN O'QUINN MD

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	207ND0101X	MOHS-Micrographic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174712228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RYAN O'QUINN MD

Provider Business Mailing Address
First Line	:	PO BOX 2317
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78298-2317
Country	:	US
Telephone Number	:	210-558-6288
Fax Number	:	210-558-6289

Provider Business Practice Location Address
First Line	:	9238 FLOYD CURL DR
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1690
Country	:	US
Telephone Number	:	210-558-6234
Fax Number	:	210-615-1840

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RYAN PATRICK O'QUINN
Credential	:	MD
Telephone Number	:	210-558-6234

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	08/12/2015

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