Provider Demographics
NPI:1205990207
Name:CRAVEY, RUSSELL S (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:S
Last Name:CRAVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 294869
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-4869
Mailing Address - Country:US
Mailing Address - Phone:830-257-4417
Mailing Address - Fax:830-257-1480
Practice Address - Street 1:1001 WATER ST
Practice Address - Street 2:STE. E100
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3523
Practice Address - Country:US
Practice Address - Phone:830-257-4417
Practice Address - Fax:830-257-1480
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ6394207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A7630OtherBCBS
TXP00158163OtherMEDICARE RR
TX122036005Medicaid
TX83439EMedicare ID - Type Unspecified
TX122036005Medicaid