Provider Demographics
NPI:1033394986
Name:RONALD D WOBIG MD PC
Entity Type:Organization
Organization Name:RONALD D WOBIG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOBIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-757-8100
Mailing Address - Street 1:1128 NE 2ND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6298
Mailing Address - Country:US
Mailing Address - Phone:541-757-8100
Mailing Address - Fax:541-754-2707
Practice Address - Street 1:1128 NE 2ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6230
Practice Address - Country:US
Practice Address - Phone:541-757-8100
Practice Address - Fax:541-754-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134132Medicaid
OR134132Medicaid
OR5377250001Medicare NSC
ORR120807Medicare PIN
G70494Medicare UPIN