Provider Demographics
NPI:1306834601
Name:WOBIG, RONALD D (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:D
Last Name:WOBIG
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 1:1128 NE 2ND ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6230
Mailing Address - Country:US
Mailing Address - Phone:541-757-8100
Mailing Address - Fax:541-754-2707
Practice Address - Street 1:1128 NE 2ND STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6227
Practice Address - Country:US
Practice Address - Phone:541-757-8100
Practice Address - Fax:541-754-2707
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19704207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134132Medicaid
5377250001Medicare NSC
ORP00441178Medicare PIN
R120809Medicare PIN
120809Medicare PIN
G70494Medicare UPIN
OR5377250001Medicare PIN