Provider Demographics
NPI:1003057498
Name:RONNIE CLAIBORNE M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RONNIE CLAIBORNE M.D. A PROFESSIONAL CORPORATION
Other - Org Name:CENTRAL VALLEY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAIBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-323-2295
Mailing Address - Street 1:1925 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4201
Mailing Address - Country:US
Mailing Address - Phone:661-323-2295
Mailing Address - Fax:661-323-8040
Practice Address - Street 1:1925 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4201
Practice Address - Country:US
Practice Address - Phone:661-323-2295
Practice Address - Fax:661-323-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66649208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G666491Medicaid
CA1578503256OtherINDIVIDUAL NPI
CA00G666491Medicaid