MEDICARE: DR. RYAN P. O'QUINN M.D.

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	L5077	TX

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	:	1205881281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN P. O'QUINN M.D.

Provider Business Mailing Address
First Line	:	2632 BROADWAY ST STE 300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1137
Country	:	US
Telephone Number	:	210-558-6234
Fax Number	:	210-446-5039

Provider Business Practice Location Address
First Line	:	2632 BROADWAY ST STE 300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1137
Country	:	US
Telephone Number	:	210-558-6234
Fax Number	:	210-446-5039

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	01/30/2020

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