Provider Demographics
NPI:1336196260
Name:BRASWELL, RONALD ALVIN (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ALVIN
Last Name:BRASWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 RUMMEL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4205
Mailing Address - Country:US
Mailing Address - Phone:205-329-3590
Mailing Address - Fax:
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:205-329-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU1173207W00000X
MN69416207W00000X
MS11496207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL925496OtherBLOCK VISION
ALA98959OtherHEALTHSPRING
AL009963855Medicaid
ALP00196342OtherRAILROAD MEDICARE
ALA98959OtherVIVA
MS00015714OtherMISSISSIPPI MEDICAID
AL051523422OtherBLUE CROSS