Provider Demographics
NPI:1578503256
Name:CLAIBORNE, RONNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
Last Name:CLAIBORNE
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 1:1925 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4201
Mailing Address - Country:US
Mailing Address - Phone:661-323-2295
Mailing Address - Fax:661-323-8040
Practice Address - Street 1:1925 17TH STREET
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5012
Practice Address - Country:US
Practice Address - Phone:661-323-2295
Practice Address - Fax:661-323-8040
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66649208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G666491Medicaid
CA00G666490Medicare ID - Type Unspecified
CAE97256Medicare UPIN