MEDICARE: RYAN DONAHUE

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208800000X	Urology Physician	S9126	TX

General Provider Information

NPI Number	:	1922453836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN DONAHUE

Provider Business Mailing Address
First Line	:	2326 WATERFORD GRACE
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-9574
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	876 LOOP 337 STE 302
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-3553
Country	:	US
Telephone Number	:	830-625-8088
Fax Number	:

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

Provider Enumeration Date	:	04/28/2016
Last Update Date	:	07/13/2021

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Directions to “ RYAN DONAHUE ” Practice Location

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