Individual
RYAN KOSTKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1500 S MAIN ST FL 2, FORT WORTH, TX 76104-4917
(817) 702-3000
(817) 927-3958
Mailing address
7214 LA VISTA DR, DALLAS, TX 75214-4226
(720) 201-4084
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
T0543
TX
2086S0102X
Surgical Critical Care Physician
Primary
T0543
TX
2086S0127X
Trauma Surgery Physician
T0543
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2016
Last updated
08/02/2022
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