Provider Demographics
NPI:1588653547
Name:KORN, RONALD LEE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LEE
Last Name:KORN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 W ROSE GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2530
Mailing Address - Country:US
Mailing Address - Phone:602-521-6252
Mailing Address - Fax:623-842-5640
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5648
Practice Address - Country:US
Practice Address - Phone:480-425-5000
Practice Address - Fax:480-945-6548
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ347759Medicaid
AZ347759Medicaid
AZWCMBK16Medicare PIN
G29031Medicare UPIN
AZ79054Medicare PIN