Provider Demographics
NPI:1447323183
Name:RAVEL, RICHARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:RAVEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 BURNET RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-1603
Mailing Address - Country:US
Mailing Address - Phone:512-459-7603
Mailing Address - Fax:512-459-7604
Practice Address - Street 1:5525 BURNET RD
Practice Address - Street 2:SUITE 1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1603
Practice Address - Country:US
Practice Address - Phone:512-459-7603
Practice Address - Fax:512-459-7604
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332BC3200X332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ05049711Medicaid
TX0671970001Medicare NSC