Provider Demographics
NPI:1225153315
Name:SHIMMIN, RONALD K (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:K
Last Name:SHIMMIN
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 1:5080 SPECTRUM DR
Mailing Address - Street 2:SUITE 1200 WEST
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:972-364-8000
Mailing Address - Fax:
Practice Address - Street 1:1146 SAN MARINO DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4649
Practice Address - Country:US
Practice Address - Phone:760-471-2033
Practice Address - Fax:760-471-2083
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA370552083X0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE921UMedicare UPIN
CACE921SMedicare UPIN
CACE921TMedicare UPIN
CACE921VMedicare UPIN
CACE921WMedicare UPIN
CACE921ZMedicare UPIN
CACE921XMedicare UPIN
CACE921YMedicare UPIN