Provider Demographics
NPI:1316946940
Name:LOUCKS, RONALD JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:LOUCKS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 ROBERT THOMPSON DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2323
Mailing Address - Country:US
Mailing Address - Phone:636-931-9600
Mailing Address - Fax:636-933-9116
Practice Address - Street 1:1557 ROBERT THOMPSON DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2323
Practice Address - Country:US
Practice Address - Phone:636-931-9600
Practice Address - Fax:636-933-9116
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2008-04-04
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
MO000792213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO124083OtherBLUE CROSS/BLUE SHIELD
MO408100OtherHEALTHLINK
MOP00184813OtherRAILROAD MEDICARE
MO5216600001Medicare NSC
MOU73219Medicare UPIN