Provider Demographics
NPI:1073551032
Name:RISLEY, RONALD P (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:P
Last Name:RISLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 HOWE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-5507
Mailing Address - Country:US
Mailing Address - Phone:916-282-0889
Mailing Address - Fax:916-266-6372
Practice Address - Street 1:440 HOWE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-5507
Practice Address - Country:US
Practice Address - Phone:916-282-0889
Practice Address - Fax:916-266-6372
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63721207Q00000X
CADEA BR5656030207Q00000X
CAA0637212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H41962Medicare UPIN