Provider Demographics
NPI:1285722488
Name:FRUG, RONALD MAX (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:MAX
Last Name:FRUG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 9089
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728
Mailing Address - Country:US
Mailing Address - Phone:714-431-0303
Mailing Address - Fax:714-431-0393
Practice Address - Street 1:17815 NEWHOPE STREET
Practice Address - Street 2:SUITE S
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-431-0303
Practice Address - Fax:714-431-0393
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA207892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A207890Medicaid
7P115Medicare ID - Type Unspecified
CA00A207890Medicaid