Provider Demographics
NPI:1316992373
Name:IVERSON, RONALD EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EDWARD
Last Name:IVERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1387 SANTA RITA RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-5643
Mailing Address - Country:US
Mailing Address - Phone:925-462-3700
Mailing Address - Fax:925-462-4681
Practice Address - Street 1:1387 SANTA RITA RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-5643
Practice Address - Country:US
Practice Address - Phone:925-462-3700
Practice Address - Fax:925-462-4681
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA0G147380208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-1102OtherBLUE CROSS
CA05-1102OtherBLUE CROSS
CAA39323Medicare UPIN