Individual
MR. RYAN JACK MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
9301 N CENTRAL EXPY STE 500, DALLAS, TX 75231-0805
(214) 220-2468
(469) 232-9738
Mailing address
9301 N CENTRAL EXPY STE 500, DALLAS, TX 75231-0805
(214) 220-2468
(469) 232-9738
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
PA03455
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281283601
—
TX
05
—
281283602
—
TX
05
—
281283603
—
TX
01
—
PA03455
STATE LICENSE
TX
Enumeration date
02/21/2007
Last updated
06/01/2022
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