Healthcare Provider Details

I. General information

NPI: 1154334092
Provider Name (Legal Business Name): RONALD JOHN CULLEN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E 9TH ST
BONHAM TX
75418-4059
US

IV. Provider business mailing address

117 GOLDEN RD
SHERMAN TX
75090-7511
US

V. Phone/Fax

Practice location:
  • Phone: 903-583-6358
  • Fax:
Mailing address:
  • Phone: 903-546-2145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number52960
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: