Provider Demographics
NPI:1962430876
Name:YAMAMOTO, RONALD KOJI (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:KOJI
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 WESTPARK WAY
Mailing Address - Street 2:STE A
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040
Mailing Address - Country:US
Mailing Address - Phone:817-267-4238
Mailing Address - Fax:817-545-7569
Practice Address - Street 1:425 WESTPARK WAY
Practice Address - Street 2:STE A
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040
Practice Address - Country:US
Practice Address - Phone:817-267-4238
Practice Address - Fax:817-545-7569
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5291207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00AR98OtherBCBS
TX00AR98OtherBCBS