Provider Demographics
NPI:1073648119
Name:RONALD W SHRECK M D INC
Entity Type:Organization
Organization Name:RONALD W SHRECK M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SHRECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-242-7020
Mailing Address - Street 1:407 E CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5814
Mailing Address - Country:US
Mailing Address - Phone:580-242-7020
Mailing Address - Fax:580-233-1617
Practice Address - Street 1:407 E CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5814
Practice Address - Country:US
Practice Address - Phone:580-242-7020
Practice Address - Fax:580-233-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11370208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100129380AMedicaid
OK100129380AMedicaid
OKC95495Medicare UPIN