MEDICARE: JOHN RAYMOND ERNST PA-C

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	363A00000X	Physician Assistant	1108109	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134470388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN RAYMOND ERNST PA-C

Provider Business Mailing Address
First Line	:	170 DEEP WOOD DR STE 105
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-4949
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4204 E STAN SCHLUETER LOOP
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-8352
Country	:	US
Telephone Number	:	916-742-3215
Fax Number	:

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

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	12/28/2023

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