Provider Demographics
NPI:1821125204
Name:RONALD DEVERE, MD PA
Entity Type:Organization
Organization Name:RONALD DEVERE, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-261-7909
Mailing Address - Street 1:1200 LAKEWAY DR STE 8
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 LAKEWAY DR STE 8
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4456
Practice Address - Country:US
Practice Address - Phone:512-261-7909
Practice Address - Fax:512-402-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE32532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00967GMedicare ID - Type Unspecified
TXC15205Medicare UPIN