Provider Demographics
NPI:1144361809
Name:RANSDELL, BRIAN L (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:RANSDELL
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 1:4900 BEE CREEK RD # 101
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-6776
Mailing Address - Country:US
Mailing Address - Phone:512-961-5250
Mailing Address - Fax:512-961-5014
Practice Address - Street 1:4900 BEE CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-6776
Practice Address - Country:US
Practice Address - Phone:512-961-5250
Practice Address - Fax:512-961-5014
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4463207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186397903Medicaid
TX186397901Medicaid
TX8J3649Medicare PIN
TX8J3652Medicare PIN
TX8J3650Medicare PIN