Provider Demographics
NPI:1033105275
Name:ALM, RONALD W (DPM)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:ALM
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 1:803 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3733
Mailing Address - Country:US
Mailing Address - Phone:208-743-2091
Mailing Address - Fax:208-743-5444
Practice Address - Street 1:803 16TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-3733
Practice Address - Country:US
Practice Address - Phone:208-743-2091
Practice Address - Fax:208-743-5444
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2020-02-24
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
IDP127213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0013290Medicaid
WA1048552OtherWASHINGTON MEDICAID
WA0064483OtherL&I
ID0667930001Medicare NSC
WA0064483OtherL&I
ID1350637Medicare PIN
ID1350636Medicare PIN