Provider Demographics
NPI:1164411807
Name:MCDANIEL, RONALD RAY (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:RAY
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6420
Mailing Address - Country:US
Mailing Address - Phone:817-599-4301
Mailing Address - Fax:817-599-4399
Practice Address - Street 1:1710 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6420
Practice Address - Country:US
Practice Address - Phone:817-599-4301
Practice Address - Fax:817-599-4399
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-16
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000354383Medicaid
TXQE53Medicare ID - Type Unspecified
TX000354383Medicaid