Provider Demographics
NPI:1326154394
Name:SHRECK, RONALD WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WAYNE
Last Name:SHRECK
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 1:407 E CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5814
Mailing Address - Country:US
Mailing Address - Phone:580-242-7020
Mailing Address - Fax:580-233-1617
Practice Address - Street 1:407 E CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5814
Practice Address - Country:US
Practice Address - Phone:580-242-7020
Practice Address - Fax:580-233-1617
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11370208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100129380AMedicaid
OK100129380AMedicaid
OKC95495Medicare UPIN