Provider Demographics
NPI:1497770572
Name:DAVIS, RONALD STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:STEPHEN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1303 MCCULLOUGH AVE
Mailing Address - Street 2:#525
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5609
Mailing Address - Country:US
Mailing Address - Phone:210-225-2769
Mailing Address - Fax:210-225-7576
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:#525
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5609
Practice Address - Country:US
Practice Address - Phone:210-225-2769
Practice Address - Fax:210-225-7576
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0686207N00000X
LAMD.013075207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1010189Medicaid
A87994Medicare UPIN
LA4K577Medicare PIN