Provider Demographics
NPI:1477648301
Name:RANELLE, BRIAN D (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:RANELLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1872 NORWOOD DR
Mailing Address - Street 2:200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3066
Mailing Address - Country:US
Mailing Address - Phone:817-540-6060
Mailing Address - Fax:817-553-7994
Practice Address - Street 1:1872 NORWOOD DR
Practice Address - Street 2:200
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3066
Practice Address - Country:US
Practice Address - Phone:817-540-6060
Practice Address - Fax:817-553-7994
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE1396207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0540Medicare PIN
TXB25775Medicare UPIN
TX8B2362Medicare PIN