Provider Demographics
NPI:1295263598
Name:DAVID M. DRANETZ, M.D., P.L.L.C.
Entity type:Organization
Organization Name:DAVID M. DRANETZ, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:DRANETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-292-5366
Mailing Address - Street 1:3515 LONGMIRE DRIVE
Mailing Address - Street 2:SUITE B BOX 178
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5489
Mailing Address - Country:US
Mailing Address - Phone:508-292-5366
Mailing Address - Fax:866-459-7478
Practice Address - Street 1:3322 LONGMIRE DR STE 100
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6088
Practice Address - Country:US
Practice Address - Phone:979-200-2043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK59062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty