Provider Demographics
NPI:1619105079
Name:RONALD K MCCRAW, PHD, DO, PA
Entity Type:Organization
Organization Name:RONALD K MCCRAW, PHD, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:MCCRAW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, DO, PA
Authorized Official - Phone:409-727-8007
Mailing Address - Street 1:2300 HIGHWAY 365
Mailing Address - Street 2:SUITE 610
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6256
Mailing Address - Country:US
Mailing Address - Phone:409-727-8007
Mailing Address - Fax:409-727-8033
Practice Address - Street 1:2300 HIGHWAY 365
Practice Address - Street 2:SUITE 610
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6256
Practice Address - Country:US
Practice Address - Phone:409-727-8007
Practice Address - Fax:409-727-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23171103TC0700X
TXJ0112207V00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126999502Medicaid
TX126999503Medicaid
TX126999503Medicaid