Provider Demographics
NPI:1407876014
Name:MENARD, RALPH GEORGE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:GEORGE
Last Name:MENARD
Suffix:JR
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 1:205 W WINDCREST ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 W WINDCREST ST STE 350
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4478
Practice Address - Country:US
Practice Address - Phone:830-990-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5592208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130355404Medicaid
050012360OtherMEDICARE RAILROAD BEFORE 5/27/08
TX00J04KOtherBLUE CROSS BLUE SHIELD
TXH5592OtherSTATE LICENSE NUMBER
P00473907OtherMEDICARE RAILROAD AFTER 5/27/08
TX130355404Medicaid
P00473907OtherMEDICARE RAILROAD AFTER 5/27/08