Provider Demographics
NPI:1831192046
Name:RANELLE, H WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:H
Middle Name:WILLIAM
Last Name:RANELLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COLLINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3606
Mailing Address - Country:US
Mailing Address - Phone:817-732-5593
Mailing Address - Fax:817-732-5499
Practice Address - Street 1:5000 COLLINWOOD AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3606
Practice Address - Country:US
Practice Address - Phone:817-732-5593
Practice Address - Fax:817-732-5499
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5460207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084873101Medicaid
TX128595901Medicaid
A67537Medicare UPIN
TX00R70TMedicare ID - Type UnspecifiedGROUP
TX128595901Medicaid