1104802800 NPI number — DR. RONALD K STERRENBERG DO

Table of content: DR. RONALD K STERRENBERG DO (NPI 1104802800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104802800 NPI number — DR. RONALD K STERRENBERG DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STERRENBERG
Provider First Name:
RONALD
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104802800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7815 W KERRY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85308-6122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-561-0443
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18701 N 67TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-7100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-561-7222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  2028 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3981220 . This is a "EVERCARE GRP NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AW1436 . This is a "HEALTHNET GRP NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 183184 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 453051001 . This is a "GROUP HEALTH GROUP NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 860373636 . This is a "HUMANA GROUP NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0728670 . This is a "BLUE CROSS BLUE SHIELD GR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com