Provider Demographics
NPI:1477521532
Name:BINGHAM, RONALD CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:CRAIG
Last Name:BINGHAM
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 1:3035 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3411
Mailing Address - Country:US
Mailing Address - Phone:731-664-0899
Mailing Address - Fax:731-664-0946
Practice Address - Street 1:3035 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3411
Practice Address - Country:US
Practice Address - Phone:731-664-0899
Practice Address - Fax:731-664-0946
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000019569204R00000X, 208100000X
MS13290204R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3857438Medicaid
TNP00222025OtherRAILROAD MEDICARE NO
TN000000007457OtherTLC INDIVDUAL NO
TN4105383OtherBCBS OF TENNESSEE
TN000000165519OtherUNISON NO
TN165324700OtherUS DEPT OF LABOR
TN000000007457OtherTLC INDIVDUAL NO
TN000000165519OtherUNISON NO
KYP400022420Medicare PIN
TN103I258650Medicare PIN