Provider Demographics
NPI:1376650267
Name:SUGIYAMA, RONALD K (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:K
Last Name:SUGIYAMA
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2517 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2409
Practice Address - Country:US
Practice Address - Phone:360-748-8632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024303207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA180012491OtherRAIL ROAD MEDICARE
WA180040117OtherRAIL ROAD MEDICARE
WA180040118OtherRAIL ROAD MEDICARE
AK180041770OtherRAIL ROAD MEDICARE
WA180040118OtherRAIL ROAD MEDICARE
AK180041770OtherRAIL ROAD MEDICARE
A08969Medicare UPIN
WA180040117OtherRAIL ROAD MEDICARE
OR180041769OtherRAIL ROAD MEDICARE
ORR018WFBNKCMedicare PIN
WAG000164903Medicare PIN
WAG000355054Medicare PIN
WA180012491OtherRAIL ROAD MEDICARE
WAG000985504Medicare PIN
WAG001056803Medicare PIN