Provider Demographics
NPI:1417922352
Name:WALCHER, RONALD R (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:R
Last Name:WALCHER
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 1:600 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:TONKAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74653-3545
Mailing Address - Country:US
Mailing Address - Phone:580-628-2557
Mailing Address - Fax:580-628-2132
Practice Address - Street 1:600 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:TONKAWA
Practice Address - State:OK
Practice Address - Zip Code:74653-3545
Practice Address - Country:US
Practice Address - Phone:580-628-2557
Practice Address - Fax:580-628-2132
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100255780CMedicaid
OKD35376Medicare UPIN