Provider Demographics
NPI:1427086016
Name:BRYCE, RONALD (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:BRYCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2220
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-1573
Mailing Address - Country:US
Mailing Address - Phone:469-337-5975
Mailing Address - Fax:
Practice Address - Street 1:326 PIERCE RD
Practice Address - Street 2:BOX 2220
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-6418
Practice Address - Country:US
Practice Address - Phone:469-337-5975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1932183Medicaid
TXE02244Medicare UPIN
TX1932183Medicaid