Provider Demographics
NPI:1053311647
Name:GARRETT-ROE, RONALD DUANE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DUANE
Last Name:GARRETT-ROE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 BURNEY DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2708
Mailing Address - Country:US
Mailing Address - Phone:361-993-1083
Mailing Address - Fax:361-356-1850
Practice Address - Street 1:4929 BURNEY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2708
Practice Address - Country:US
Practice Address - Phone:361-993-1083
Practice Address - Fax:361-356-1850
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22887Medicare ID - Type UnspecifiedMEDICARE