Provider Demographics
NPI:1063498210
Name:PHILLIPS, RONALD LELAND (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LELAND
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 CROWN DR
Mailing Address - Street 2:SUITE 200 P O BOX R
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2510
Mailing Address - Country:US
Mailing Address - Phone:660-665-3838
Mailing Address - Fax:660-665-0130
Practice Address - Street 1:1 CROWN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2510
Practice Address - Country:US
Practice Address - Phone:660-665-3838
Practice Address - Fax:660-665-0130
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR5B09207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10201Medicare UPIN