Provider Demographics
NPI:1194833228
Name:ZOHNER, RONALD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
Last Name:ZOHNER
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 1:1842 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4415
Mailing Address - Country:US
Mailing Address - Phone:208-552-5707
Mailing Address - Fax:208-552-5709
Practice Address - Street 1:1842 1ST ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4415
Practice Address - Country:US
Practice Address - Phone:208-552-5707
Practice Address - Fax:208-552-5709
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM56812084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010004266OtherBLUE SHIELD
ID000911100Medicaid
ID56812OtherBLUE CROSS
IDE69404Medicare UPIN
ID000911100Medicaid