Provider Demographics
NPI:1912982190
Name:LEDBETTER, BILLY RAY JR (MD)
Entity type:Individual
Prefix:DR
First Name:BILLY
Middle Name:RAY
Last Name:LEDBETTER
Suffix:JR
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 1:4208 YUCCA FLATS TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-8324
Mailing Address - Country:US
Mailing Address - Phone:817-237-6600
Mailing Address - Fax:
Practice Address - Street 1:11813 BEE CAVES RD STE B
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738
Practice Address - Country:US
Practice Address - Phone:512-505-8645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-11
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6545208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice