Provider Demographics
NPI:1306043864
Name:PENDLEY, RONALD DEAN (C-PED)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DEAN
Last Name:PENDLEY
Suffix:
Gender:M
Credentials:C-PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 S. PENNSYLVANIA AV. SUITE 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4257
Mailing Address - Country:US
Mailing Address - Phone:405-692-3831
Mailing Address - Fax:405-692-3810
Practice Address - Street 1:10600 S PENNSYLVANIA AVE STE 5
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-4257
Practice Address - Country:US
Practice Address - Phone:405-692-3831
Practice Address - Fax:405-692-3810
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist