Provider Demographics
NPI:1225089535
Name:CHENEY, RONALD A (DO)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:A
Last Name:CHENEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51449-1585
Mailing Address - Country:US
Mailing Address - Phone:712-464-7907
Mailing Address - Fax:712-464-7412
Practice Address - Street 1:1351 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:IA
Practice Address - Zip Code:51449-1585
Practice Address - Country:US
Practice Address - Phone:712-464-7907
Practice Address - Fax:712-464-7412
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE301208600000X
IADO-03087208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
274409Medicare ID - Type Unspecified
H42540Medicare UPIN