Healthcare Provider Details

I. General information

NPI: 1164411807
Provider Name (Legal Business Name): RONALD RAY MCDANIEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2005
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 SANTA FE DR
WEATHERFORD TX
76086-6420
US

IV. Provider business mailing address

1710 SANTA FE DR
WEATHERFORD TX
76086-6420
US

V. Phone/Fax

Practice location:
  • Phone: 817-599-4301
  • Fax: 817-599-4399
Mailing address:
  • Phone: 817-599-4301
  • Fax: 817-599-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0620
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: