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General NPI Number Information
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NPI Number | 1922155514
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Entity Type | Organization
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Legal Business Name | RAY SPAW MD PA
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 101 E JACKSON ST
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City | BURNET
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State | TX
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Zip | 78611-3101
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Country | US
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Telephone | 512-756-7510
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Fax | 512-756-0233
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Provider Business Mailing Address
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Address Line | 101 E JACKSON ST
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City | BURNET
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State | TX
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Zip | 78611-3101
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Country | US
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Telephone | 512-756-7510
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Fax | 512-756-0233
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAY G SPAW
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Credential | M.D.
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Telephone | 512-756-7510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H1452
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License Number State | TX
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