Provider Demographics
NPI:1447220538
Name:CHARLES, RONALD WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:WILLIAM
Last Name:CHARLES
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 1:1700 W TOWNLINE ST
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1054
Mailing Address - Country:US
Mailing Address - Phone:641-782-7091
Mailing Address - Fax:641-782-3830
Practice Address - Street 1:1610 W TOWNLINE ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1066
Practice Address - Country:US
Practice Address - Phone:641-782-3887
Practice Address - Fax:641-782-3504
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27934207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0600460Medicaid
IA36174OtherWMC-BCBS DME
IADA 1838OtherWMC FPC-MEDICARE RR
IA60046OtherWMC BCBS
IA163495OtherWMC FPC MEDICARE
IA33444OtherWMC FPC-BCBS
IA0293522Medicaid
IA0002105Medicaid
IA0424507Medicaid
IA0635011Medicaid
IA66046OtherWMC BCBS SNF
IA0283465Medicaid
IA03187OtherBCBS
IA0655001Medicaid
IA29352OtherWMC BCBS ER
IA33444OtherWMC FPC-BCBS
IA29352OtherWMC BCBS ER
IA163495OtherWMC FPC MEDICARE
IA16Z302Medicare Oscar/Certification