Provider Demographics
NPI:1104825538
Name:WOKASIEN, RONALD LOUIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LOUIS
Last Name:WOKASIEN
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 1:13219 RESEARCH BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3231
Mailing Address - Country:US
Mailing Address - Phone:512-250-0444
Mailing Address - Fax:512-335-1986
Practice Address - Street 1:13219 RESEARCH BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-3249
Practice Address - Country:US
Practice Address - Phone:512-250-0444
Practice Address - Fax:512-335-1986
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX674213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0187585-01Medicaid
TX00JN99Medicare ID - Type Unspecified
TX0187585-01Medicaid