Provider Demographics
NPI:1922155514
Name:RAY SPAW MD PA
Entity Type:Organization
Organization Name:RAY SPAW MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:G
Authorized Official - Last Name:SPAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-756-7510
Mailing Address - Street 1:101 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-3101
Mailing Address - Country:US
Mailing Address - Phone:512-756-7510
Mailing Address - Fax:512-756-0233
Practice Address - Street 1:101 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-3101
Practice Address - Country:US
Practice Address - Phone:512-756-7510
Practice Address - Fax:512-756-0233
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAY SPAW MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-04
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1174503163OtherDR SPAW'S NPI NUMBER