Provider Demographics
NPI:1104802800
Name:STERRENBERG, RONALD K (DO)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:K
Last Name:STERRENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7815 W KERRY LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6122
Mailing Address - Country:US
Mailing Address - Phone:623-561-0443
Mailing Address - Fax:
Practice Address - Street 1:18701 N 67TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7100
Practice Address - Country:US
Practice Address - Phone:623-561-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2028207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3981220OtherEVERCARE GRP NUMBER
AZAW1436OtherHEALTHNET GRP NUMBER
AZ183184Medicaid
AZ453051001OtherGROUP HEALTH GROUP NUMBER
AZ860373636OtherHUMANA GROUP NUMBER
AZAZ0728670OtherBLUE CROSS BLUE SHIELD GR
AZAW1436OtherHEALTHNET GRP NUMBER
AZ3981220OtherEVERCARE GRP NUMBER