Provider Demographics
NPI:1376520148
Name:SQUIRES, DAVID RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RONALD
Last Name:SQUIRES
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 1:3696 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6520
Mailing Address - Country:US
Mailing Address - Phone:706-736-1830
Mailing Address - Fax:706-737-5103
Practice Address - Street 1:3696 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6520
Practice Address - Country:US
Practice Address - Phone:706-736-1830
Practice Address - Fax:706-737-5103
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052835174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA004423OtherBLUE CROSS BLUE SHIELD
GA604802700OtherUNITED HEALTHCARE
GA851030536AMedicaid
SCG52835Medicaid
GAP00035368OtherRAILROAD MEDICARE
GAP00035368OtherRAILROAD MEDICARE
GA604802700OtherUNITED HEALTHCARE