Provider Demographics
NPI:1558465021
Name:MCADAM, RONALD L (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:MCADAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S. 20TH AVENUE
Mailing Address - Street 2:MT GRAHAM REGIONAL MEDICAL CENTER
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546
Mailing Address - Country:US
Mailing Address - Phone:928-348-4000
Mailing Address - Fax:
Practice Address - Street 1:1600 S. 20TH AVENUE
Practice Address - Street 2:MT GRAHAM REGIONAL MEDICAL CENTER
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546
Practice Address - Country:US
Practice Address - Phone:928-348-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4560207P00000X, 207PE0004X, 207PE0005X, 207PH0002X, 207PP0204X, 207PS0010X, 207PT0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000000380186OtherBCBS - GATEWAY
IN200800230Medicaid
IN000000378676OtherBCBS - MARY STREET
IN200800230Medicaid
IL000000380186OtherBCBS - GATEWAY
INI47252Medicare UPIN