Provider Demographics
NPI:1154436251
Name:RANSOM, DONALD R (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:RANSOM
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 1:4323 NW REUTLINGER
Mailing Address - Street 2:
Mailing Address - City:MEDICINE LODGE
Mailing Address - State:KS
Mailing Address - Zip Code:67104-8034
Mailing Address - Country:US
Mailing Address - Phone:620-886-3676
Mailing Address - Fax:
Practice Address - Street 1:710 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MEDICINE LODGE
Practice Address - State:KS
Practice Address - Zip Code:67104-1019
Practice Address - Country:US
Practice Address - Phone:620-886-3948
Practice Address - Fax:620-886-3034
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0521015208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100230000BMedicaid
KSE81225Medicare UPIN
KS103799Medicare ID - Type UnspecifiedCLINIC PROVIDER BILLING #