Provider Demographics
NPI:1124150214
Name:RONALD R WALCHER MD INC
Entity type:Organization
Organization Name:RONALD R WALCHER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRFESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-628-2557
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:TONKAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74653-0008
Mailing Address - Country:US
Mailing Address - Phone:580-628-2557
Mailing Address - Fax:580-628-2132
Practice Address - Street 1:600 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:TONKAWA
Practice Address - State:OK
Practice Address - Zip Code:74653-3545
Practice Address - Country:US
Practice Address - Phone:580-628-2557
Practice Address - Fax:580-628-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100255780CMedicaid
OKD35376Medicare UPIN
OK447521226Medicare ID - Type Unspecified