Provider Demographics
NPI:1245319334
Name:BARBARA RYNO DAVIDSON MD PA
Entity type:Organization
Organization Name:BARBARA RYNO DAVIDSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATION
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:RYNO
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:903-533-0699
Mailing Address - Street 1:1100 E LAKE ST STE 340
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3359
Mailing Address - Country:US
Mailing Address - Phone:903-533-0699
Mailing Address - Fax:903-597-0822
Practice Address - Street 1:1100 E LAKE ST STE 340
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3359
Practice Address - Country:US
Practice Address - Phone:903-533-0699
Practice Address - Fax:903-597-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center