MEDICARE: DR. RONALD RAY MCDANIEL D.O.

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	207Q00000X	Family Medicine Physician	H0620	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	:	1164411807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD RAY MCDANIEL D.O.

Provider Business Mailing Address
First Line	:	1710 SANTA FE DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-6420
Country	:	US
Telephone Number	:	817-599-4301
Fax Number	:	817-599-4399

Provider Business Practice Location Address
First Line	:	1710 SANTA FE DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-6420
Country	:	US
Telephone Number	:	817-599-4301
Fax Number	:	817-599-4399

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

Provider Enumeration Date	:	10/16/2005
Last Update Date	:	11/02/2011

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