Provider Demographics
NPI:1326006800
Name:PETCHER, RONALD C (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:PETCHER
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 1:2653 W GUADALUPE RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7200
Mailing Address - Country:US
Mailing Address - Phone:480-455-1860
Mailing Address - Fax:480-455-1862
Practice Address - Street 1:2653 W GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7200
Practice Address - Country:US
Practice Address - Phone:480-455-1860
Practice Address - Fax:480-455-1862
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ935281Medicaid
AZ470001313OtherRAILROAD MEDICARE
AZA88970Medicare UPIN