MEDICARE: DR. RALPH GEORGE MENARD JR. MD

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	208VP0014X	Interventional Pain Medicine Physician	H5592	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	050012360	OTHER		MEDICARE RAILROAD BEFORE 5/27/08
5	P00473907	OTHER		MEDICARE RAILROAD AFTER 5/27/08

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
3	00J04K	OTHER	TX	BLUE CROSS BLUE SHIELD
4	H5592	OTHER	TX	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1407876014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH GEORGE MENARD JR. MD

Provider Business Mailing Address
First Line	:	205 W WINDCREST ST
Second Line	:	SUITE 130
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-4479
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 W WINDCREST ST STE 350
Second Line	:
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-4478
Country	:	US
Telephone Number	:	830-990-1404
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	06/28/2017

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Directions to “ DR. RALPH GEORGE MENARD JR. MD” Practice Location

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