MEDICARE: RONALD ALVIN BRASWELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	U1173	TX
2	207W00000X	Ophthalmology Physician	69416	MN
3	207WX0109X	Neuro-ophthalmology Physician	11496	MS

General Provider Information

NPI Number	:	1336196260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD ALVIN BRASWELL MD

Provider Business Mailing Address
First Line	:	5710 RUMMEL RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-4205
Country	:	US
Telephone Number	:	205-329-3590
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 W 7TH ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-5446
Country	:	US
Telephone Number	:	205-329-3590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	11/06/2023

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