Provider Demographics
NPI:1982786174
Name:CRONIN, ERNEST DATTNER (MD)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:DATTNER
Last Name:CRONIN
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 1:1315 ST JOSEPH PARKWAY
Mailing Address - Street 2:#920
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002
Mailing Address - Country:US
Mailing Address - Phone:713-951-0400
Mailing Address - Fax:713-951-0314
Practice Address - Street 1:1315 ST JOSEPH PARKWAY
Practice Address - Street 2:#920
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002
Practice Address - Country:US
Practice Address - Phone:713-951-0400
Practice Address - Fax:713-951-0314
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD81852086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84G262OtherBCBS OF TX
TX126177802Medicaid
TX10014527OtherAMERIGROUP
TX10014527OtherAMERIGROUP
TXA56WMedicare ID - Type Unspecified