Provider Demographics
NPI:1750375465
Name:MCCRAW, RONALD KENT (PHD,DO,PA)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:KENT
Last Name:MCCRAW
Suffix:
Gender:M
Credentials:PHD,DO,PA
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:K
Other - Last Name:MCCRAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD,DO,PA
Mailing Address - Street 1:2300 HIGHWAY 365
Mailing Address - Street 2:610
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6256
Mailing Address - Country:US
Mailing Address - Phone:409-727-8007
Mailing Address - Fax:409-727-8033
Practice Address - Street 1:2300 HIGHWAY 365
Practice Address - Street 2:SUITE 610
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6256
Practice Address - Country:US
Practice Address - Phone:409-727-8007
Practice Address - Fax:409-727-8033
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0112174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126999502Medicaid
TX126999502Medicaid